The following is a summary of “Carbapenem use in extended-spectrum cephalosporin-resistant Enterobacterales infections in US hospitals and influence of IDSA guidance: a retrospective cohort study,” published in the April 2024 issue of Infectious Disease by Walker et al.
Inconsistent and frequently updated guidelines from major infectious diseases societies for managing non-severe extended-spectrum β-lactamase (ESBL)-producing Enterobacterales infections may hinder effective carbapenem stewardship.
Researchers conducted a retrospective study investigating real-world practices for treating extended-spectrum cephalosporin-resistant (ECR) Enterobacterales infections in US hospitals, focusing on factors influencing carbapenem use.
They included adult patients (18 years or older) admitted to hospitals with ECR Enterobacterales infections. The antibiotic treatment regimens were examined, categorized into empirical and targeted treatment phases, and further stratified by infection severity and location. The probability of receiving targeted carbapenems over time, before and after the initial release of the Infectious Diseases Society of America (IDSA) guidelines (September 2020), was determined using generalized estimating equations, which accounted for patient, hospital, and temporal confounders.
The result showed data from 30,041 hospitals with ECR Enterobacterales infections across 168 US hospitals (January 2018 to December 2021). Patients were evenly distributed by gender 16,006 (53.3%) female 14,035 (46.7%) male, with an average age of 67.3 years(SD 15.1). While carbapenem use was uncommon for empirical treatment 5,324 (17.7%), it became more frequent during targeted treatment phases 17,518 (58.3%). The alternative narrower-spectrum antibiotics were effective in patients without septic shock (3,031 [45.6%] of 6,651), and patients with urinary tract infections without septic shock (1,845 [46.8%] of 3,943). The transition to carbapenems occurred when the ECR phenotype was identified, regardless of infection severity. However, Carbapenems remained the dominant choice for treating ECR Enterobacterales infections during the study period (adjusted OR 1.00 [95% CI 1.00–1.00]), with no significant changes observed (1.07 [0.95–1.20]) either immediately or in the long term (0.99 [0.98–1.00]) after the release of IDSA guidelines.
Investigators concluded that US hospitals overuse carbapenems for treatable Enterobacterales infections, indicating a need for better adherence to antibiotic stewardship guidelines.
Source: thelancet.com/journals/laninf/article/PIIS1473-3099(24)00149-X/abstract#%20