The spread of extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is leading to increased carbapenem consumption. Alternatives to carbapenems need to be investigated. We investigated whether β-lactam/β-lactamase inhibitor (BLBLI) combinations are as effective as carbapenems in the treatment of bloodstream infections (BSI) due to ESBL-E. A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI due to ESBL-E were studied; specific criteria were applied for inclusion of patients in the empirical-therapy (ET) cohort (ETC; 365 patients), targeted-therapy (TT) cohort (TTC; 601 patients), and global cohort (GC; 627 patients). The main outcome variables were cure/improvement rate at day 14 and all-cause 30-day mortality. Multivariate analysis, propensity scores (PS), and sensitivity analyses were used to control for confounding. The cure/improvement rates with BLBLIs and carbapenems were 80.0% and 78.9% in the ETC and 90.2% and 85.5% in the TTC, respectively. The 30-day mortality rates were 17.6% and 20% in the ETC and 9.8% and 13.9% in the TTC, respectively. The adjusted odds ratio (OR) (95% confidence interval [CI]) values for cure/improvement rate with ET with BLBLIs were 1.37 (0.69 to 2.76); for TT, they were 1.61 (0.58 to 4.86). Regarding 30-day mortality, the adjusted OR (95% CI) values were 0.55 (0.25 to 1.18) for ET and 0.59 (0.19 to 1.71) for TT. The results were consistent in all subgroups studied, in a stratified analysis according to quartiles of PS, in PS-matched cases, and in the GC. BLBLIs, if active in vitro, appear to be as effective as carbapenems for ET and TT of BSI due to ESLB-E regardless of the source and specific species. These data may help to avoid the overuse of carbapenems. (This study has been registered at ClinicalTrials.gov under registration no. NCT01764490.).

Carbapenem

Beta-Lactamase Inhibitors

Bacteremia

10.1128/aac.00365-16

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Risk factors for bloodstream infections due to carbapenem-resistant Enterobacterales: a nested case-control-control study

Journal of Antimicrobial Chemotherapy (2024)

Hongyu Zhou Niccolò Buetti Salvador Pérez-Galera José María Bravo-Ferrer Belén Gutiérrez‐Gutiérrez

Carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs) are a major threat to patients. To date, data on risk factors have been limited, with low internal and external validity. In this multicentre study, risk factors for CRE BSI were determined by comparison with two control groups: patients with carbapenem-susceptible Enterobacterales (CSE) BSI, and patients without Enterobacterales infection (uninfected patients).

Carbapenem

Bloodstream infection

Nested case-control study

Bacteremia

10.1093/jac/dkae157

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Propensity Score and Desirability of Outcome Ranking Analysis of Ertapenem for Treatment of Nonsevere Bacteremic Urinary Tract Infections Due to Extended-Spectrum-Beta-Lactamase-Producing Enterobacterales in Kidney Transplant Recipients

Antimicrobial Agents and Chemotherapy (2021)

Belén Gutiérrez‐Gutiérrez Elena Pérez‐Nadales Salvador Pérez-Galera Mario Fernández‐Ruiz Jordi Carratalà

There are scarce data on the efficacy of ertapenem in the treatment of bacteremia due to extended-spectrum-beta-lactamase (ESBL)-producing

Ertapenem

Bacteremia

Carbapenem

10.1128/aac.01102-21

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Predictors of inappropriate antimicrobial prescription: Eight-year point prevalence surveys experience in a third level hospital in Spain

Frontiers in Pharmacology (2022)

María Núñez‐Núñez Salvador Pérez-Galera José Antonio Girón-Ortega Santiago Sandoval Fernández‐del‐Castillo Margarita Beltrán-García

Antibiotic stewardship programs (ASP) have already demonstrated clinical benefits. We aimed to describe the Point Prevalence Surveys (PPS) methodology implemented in our hospital as an efficient tool to guide ASP strategies. Annually repeated PPS were conducted from 2012 to 2019 at a 750-bed university hospital in South Spain. Key quality indicators and inappropriateness of antimicrobial treatment, defined strictly according to local guidelines, were described. Variables associated with inappropriate treatment were identified by bi/multivariable analysis. A total of 1,600 patients were included. We found that 49% of the prescriptions were inappropriate due to unnecessary treatment (14%), not first line drug recommended (14%), inadequate drug according to microbiological results (9%), unsuitable doses (8%), route (3%) or duration (7%). Samples collection presented a significant protective effect together with sepsis presentation at onset and intensive care unit admission. However, age, receiving an empirical treatment and an unknown or urinary source of the infections treated were independent risk factors for inappropriateness. Site and severity of infection were documented in medical charts by prescribers (75 and 61% respectively). PPS may allow identifying the main risk factors for inappropriateness. This simple methodology may be useful for ASP to select modifiable factors to be prioritized for targeted interventions.

Antimicrobial Stewardship

10.3389/fphar.2022.1018158

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Diabetes tipo 2 bien contralada y microalbuinuria

Revista Española de Casos Clínicos en Medicina Interna (2018)

David León Jiménez Salvador Pérez-Galera Rocío Ruíz-Hueso José Antonio Girón-Ortega José Pablo Miramontes‐González

Presentamos el caso real de una paciente de 58 años diabética tipo 2 diagnosticada en el año 2006 e insulinizada desde mayo de 2014. Además presentaba hipertensión arterial y era fumadora de 20 cig/día. Acude a consultas para control metabólico detectándose microalbuminuria, de nueva aparición, a pesar de una hemoglobina glicada de 6,5% y una tensión arterial controlada.

Microalbuminuria

10.32818/reccmi.a3s1a11

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