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- Title
Is Carbapenem Therapy Necessary for the Treatment of Non-CTX-M Extended-Spectrum β-Lactamase-Producing Enterobacterales Bloodstream Infections?
- Authors
Hareza, Dariusz A; Cosgrove, Sara E; Simner, Patricia J; Harris, Anthony D; Bergman, Yehudit; Conzemius, Rick; Jacobs, Emily; Beisken, Stephan; Tamma, Pranita D
- Abstract
Background Investigations into antibiotics for extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) bloodstream infections (BSIs) have focused on bla CTX-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: bla CTX-M (n = 370), bla SHV (n = 16), bla OXY (n = 12), and bla VEB (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 bla CTX-M genes.
- Subjects
CARBAPENEMS; ENTEROBACTERIACEAE diseases; MICROBIAL sensitivity tests; BACTEREMIA; SCIENTIFIC observation; DRUG resistance in microorganisms; TREATMENT effectiveness; DESCRIPTIVE statistics; ENZYMES; GENES; ESCHERICHIA coli; ODDS ratio; REINFECTION; RESEARCH; BETA lactamases; CONFIDENCE intervals; SEQUENCE analysis; GENOMES; KLEBSIELLA; MEROPENEM; PENICILLIN; EVALUATION; DISEASE complications
- Publication
Clinical Infectious Diseases, 2024, Vol 78, Issue 5, p1103
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciad703