title: Role of empirical and targeted therapy in hospitalized patients with bloodstream infections caused by ESBL-producing Enterobacteriaceae.
abstract: BACKGROUND
  Bloodstream infection (BSI) due to extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae are a major cause of in-hospital mortality. The effect on survival of empirical and targeted antibiotic therapy in these patients remains controversial.
  
  
  METHODS
  A prospective cohort study was conducted analyzing data from 94 patients (age 59 ± 21 years) with BSI due to ESBL producing strains (Sixty-one E. coli, 26 K. pneumoniae, 4 Proteus spp and 3 Enterobacter spp).
  
  
  RESULTS
  Risk factors associated with 21-day mortality at univariate analysis were: recent administration of antibiotic therapy (p=0.049), higher SOFA score (p=0.05), ICU stay (p <0.01), hypotension at presentation (p =0.001) or septic shock (p <0.001) and bacteremia from source other than urinary tract (p=0.03). Regardless of antibiotic class used, no differences in survival were noted between patients receiving or not adequate initial antimicrobial treatment (37.1% vs 23.7% p=0.23); on the other hand, compared with the administration of other in vitro active antibiotics, the use of carbapenem as definitive therapy was associated with a significantly lower 21-day mortality (54.3% vs 28.5% p=0.02).
  
  
  CONCLUSIONS
  These findings suggest that the administration of an adequate initial therapy is not associated with mortality in hospitalized patients with BSI due to Enterobacteriaceae. The severity of clinical conditions at presentation and the administration of carbapenems as definitive therapy seems to be really important in affecting the outcome of patients with BSI due to ESBL producing strains.
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Falcone
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Vena
authors.affiliation: Department of Bio-Medical Sciences-Section of Microbiology, University of Catania, Italy.
authors.forename: M L
authors.initials: ML
authors.lastname: Mezzatesta
authors.affiliation: Department of Bio-Medical Sciences-Section of Microbiology, University of Catania, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Gona
authors.affiliation: Department of Bio-Medical Sciences-Section of Microbiology, University of Catania, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Caio
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Goldoni
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Trancassini
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Conti
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
authors.forename: G B
authors.initials: GB
authors.lastname: Orsi
authors.affiliation: Hospital San Giovanni in Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Carfagna
authors.affiliation: Department of Bio-Medical Sciences-Section of Microbiology, University of Catania, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Stefani
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Venditti
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D015780:Carbapenems / Q000627:therapeutic use; D004755:Enterobacteriaceae / Q000201:enzymology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D001618:beta-Lactamases