RESUMEN
BACKGROUND: There is little evidence of the impact of antimicrobial stewardship programmes on antimicrobial resistance. OBJECTIVES: To study the efficacy and safety of a package of educational and interventional measures to optimize linezolid use and its impact on bacterial resistance. METHODS: A quasi-experimental study was designed and carried out before and after implementation of a stewardship programme in hospitalized patients with Gram-positive infections treated with linezolid. RESULTS: The intervention reduced linezolid consumption by 76%. The risk of linezolid-resistant CoNS isolates (ORâ=â0.37; 95% CIâ=â0.27-0.49; Pâ<â0.001) and Enterococcus faecalis (ORâ=â0.44; 95% CIâ=â0.21-0.90; Pâ=â0.03) during the intervention period was lower than in the pre-intervention period. CONCLUSIONS: A programme to optimize linezolid use can contribute to reducing the resistance rate of CoNS and E. faecalis to this antibiotic.
Asunto(s)
Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana , Utilización de Medicamentos/normas , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Política de Salud , Linezolid/uso terapéutico , Antibacterianos/farmacología , Actitud del Personal de Salud , Terapia Conductista , Educación Médica Continua/métodos , Enterococcus faecalis/efectos de los fármacos , Enterococcus faecalis/aislamiento & purificación , Hospitales Universitarios , Humanos , Linezolid/farmacología , Ensayos Clínicos Controlados no Aleatorios como Asunto , Estudios Retrospectivos , Staphylococcus/efectos de los fármacos , Staphylococcus/aislamiento & purificación , Encuestas y Cuestionarios , Centros de Atención TerciariaRESUMEN
OBJECTIVES: Data about the efficacy of ertapenem for the treatment of bloodstream infections (BSI) due to ESBL-producing Enterobacteriaceae (ESBL-E) are limited. We compared the clinical efficacy of ertapenem and other carbapenems in monomicrobial BSI due to ESBL-E. METHODS: A multinational retrospective cohort study (INCREMENT project) was performed (ClinicalTrials.gov identifier: NCT01764490). Patients given monotherapy with ertapenem or other carbapenems were compared. Empirical and targeted therapies were analysed. Propensity scores were used to control for confounding; sensitivity analyses were performed in subgroups. The outcome variables were cure/improvement rate at day 14 and all-cause 30 day mortality. RESULTS: The empirical therapy cohort (ETC) and the targeted therapy cohort (TTC) included 195 and 509 patients, respectively. Cure/improvement rates were 90.6% with ertapenem and 75.5% with other carbapenems (Pâ=â0.06) in the ETC and 89.8% and 82.6% (Pâ=â0.02) in the TTC, respectively; 30 day mortality rates were 3.1% and 23.3% (Pâ=â0.01) in the ETC and 9.3% and 17.1% (Pâ=â0.01) in the TTC, respectively. Adjusted ORs (95% CI) for cure/improvement with empirical and targeted ertapenem were 1.87 (0.24-20.08; Pâ=â0.58) and 1.04 (0.44-2.50; Pâ=â0.92), respectively. For the propensity-matched cohorts it was 1.18 (0.43-3.29; Pâ=â0.74). Regarding 30 day mortality, the adjusted HR (95% CI) for targeted ertapenem was 0.93 (0.43-2.03; Pâ=â0.86) and for the propensity-matched cohorts it was 1.05 (0.46-2.44; Pâ=â0.90). Sensitivity analyses were consistent except for patients with severe sepsis/septic shock, which showed a non-significant trend favouring other carbapenems. CONCLUSIONS: Ertapenem appears as effective as other carbapenems for empirical and targeted therapy of BSI due to ESBL-E, but further studies are needed for patients with severe sepsis/septic shock.