Is Carbapenem Therapy Necessary for the Treatment of Non-CTX-M Extended-Spectrum β-Lactamase-Producing Enterobacterales Bloodstream Infections?

Autor:	Hareza DA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Cosgrove SE; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Simner PJ; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Harris AD; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Bergman Y; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Conzemius R; Ares Genetics, Vienna, Austria., Jacobs E; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Beisken S; Ares Genetics, Vienna, Austria., Tamma PD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2024 May 15; Vol. 78 (5), pp. 1103-1110.
DOI:	10.1093/cid/ciad703
Abstrakt:	Background: Investigations into antibiotics for extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) bloodstream infections (BSIs) have focused on blaCTX-M genes. Patient outcomes from non-CTX-M-producing ESBL-E BSIs and optimal treatment are unknown. Methods: A multicenter observational study investigating 500 consecutive patients with ceftriaxone-resistant Enterobacterales BSIs during 2018-2022 was conducted. Broth microdilution and whole-genome sequencing confirmed antibiotic susceptibilities and ESBL gene presence, respectively. Inverse probability weighting (IPW) using propensity scores ensured patients with non-CTX-M and CTX-M ESBL-E BSIs were similar before outcome evaluation. Results: 396 patients (79.2%) were confirmed to have an ESBL-E BSI. ESBL gene family prevalence was as follows: blaCTX-M (n = 370), blaSHV (n = 16), blaOXY (n = 12), and blaVEB (n = 5). ESBL gene identification was not limited to Escherichia coli and Klebsiella species. In the IPW cohort, there was no difference in 30-day mortality or ESBL-E infection recurrence between the non-CTX-M and CTX-M groups (odds ratio [OR], 0.99; 95% confidence interval [CI], .87-1.11; P = .83 and OR, 1.10; 95% CI, .85-1.42; P = .47, respectively). In an exploratory analysis limited to the non-CTX-M group, 86% of the 21 patients who received meropenem were alive on day 30; none of the 5 patients who received piperacillin-tazobactam were alive on day 30. Conclusions: Our findings suggest that non-CTX-M and CTX-M ESBL-E BSIs are equally concerning and associated with similar clinical outcomes. Meropenem may be associated with improved survival in patients with non-CTX-M ESBL-E BSIs, underscoring the potential benefit of comprehensive molecular diagnostics to enable early antibiotic optimization for ESBL-E BSIs beyond just blaCTX-M genes. Competing Interests: Potential conflicts of interest. A. D. H. reports consulting fees from Inviva for Advisory Board participation and payment from UpToDate for a role as Infection Control Editor. S. E. C. reports payment from Debiopharm for participation on an advisory board or data and safety monitoring board, outside of the submitted work; and board member roles for the National Foundation for Infectious Diseases and GARDP-NA. P. J. S. reports grants and personal fees from Accelerate Diagnostics, OpGen, QIAGEN Sciences Inc, and BD Diagnostics; grants from bioMerieux, Inc, Affinity Biosensors, T2 Diagnostics, and Hardy Diagnostics; personal consulting fees from Roche Diagnostics, Shionogi, Inc, Innoviva Therapeutics, Entasis, Merck & Co, Day Zero Diagnostic, Next Gen Diagnostics, and GeneCapture, outside the submitted work; payment or honoraria for speaking engagements from GenMark Dx, OpGen Inc, and BD Diagnostics; and stock or stock options from GeneCapture, Day Zero Diagnostics, and Next Gen Diagnostics. R. C. and S. B. are employees of Ares Genetics GmbH. S. B. also reports stock or stock options from OpGen Inc. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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