Efficacy of empirical therapy with non-carbapenems for XXXX with extended-spectrum beta-lactamase-producing Enterobacteriaceae.

@entity1 @entity281 @entity2893 @entity293
OBJECTIVES: Carbapenems are first-line agents for severe @entity281 with extended-spectrum beta-lactamase (ESBL)-producing bacteria. The use of carbapenems, however, is associated with the emergence of resistant organisms. We investigated the effects of empirical therapy with non-carbapenems on @entity293 ( @entity293 ) with ESBL-producing Enterobacteriaceae in a hospital where antimicrobial stewardship has been established. METHODS: This retrospective chart review was undertaken at a tertiary care hospital where antimicrobial stewardship and restriction of carbapenems has been established. @entity1 with a UTI with ESBL-producing Enterobacteriaceae were stratified into susceptible and non-susceptible therapy groups according to the susceptibility of the causative organism to the initial antimicrobial therapy. Outcome measures were the duration of antimicrobial therapy, 14-day mortality, infection-related mortality, and clinical cure. RESULTS: Of 90 @entity1 , 30 (33.3%) exhibited susceptible therapy. However, no significant difference was observed in the duration of antimicrobial therapy, 14-day mortality, infection-related mortality, or clinical cure between the susceptible and non-susceptible groups. Multivariate analyses revealed that the independent risk factor for 14-day morality was the use of immunosuppressive agents (odds ratio 5.23, 95% confidence interval 1.26-24.04; p=0.023). CONCLUSIONS: Non- @entity2893 therapy against @entity293 with ESBL-producing Enterobacteriaceae does not pose a significant risk to @entity1 who are not taking immunosuppressive agents.
