{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T04:20:53Z","timestamp":1780633253815,"version":"3.54.1"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2017,5,16]],"date-time":"2017-05-16T00:00:00Z","timestamp":1494892800000},"content-version":"vor","delay-in-days":135,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Carbapenems are widely used for the management of bloodstream infections (BSIs) caused by extended-spectrum \u03b2-lactamase-producing Enterobacteriaceae (ESBL-PE). However, the wide use of carbapenems has been associated with carbapenem-resistant Enterobacteriaceae development.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched the PubMed and Scopus databases (last search date was on June 1, 2016) looking for studies that reported mortality in adult patients with ESBL-PE BSIs that were treated with carbapenems or \u03b2-lactam\/\u03b2-lactamase inhibitors (BL\/BLIs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fourteen studies reported mortality data in adult patients with ESBL-PE BSI that were treated with carbapenems or BL\/BLIs. Among them, 13 studies reported extractable data on empiric therapy, with no statistically significant difference in mortality of patients with ESBL-PE BSI that were treated empirically with carbapenems (22.1%; 121 of 547), compared with those that received empiric BL\/BLIs (20.5%; 109 of 531; relative risk [RR], 1.05; 95% confidence interval [CI], 0.83\u20131.37; I2 = 20.7%; P = .241). In addition, 7 studies reported data on definitive therapy. In total, 767 patients (79.3%) received carbapenems and 199 patients (20.6%) received BL\/BLIs as definitive therapy, and there was again no statistically significant difference (RR, 0.62; 95% CI, 0.25\u20131.52; I2 = 84.6%; P &amp;lt; .001). Regarding specific pathogens, the use of empiric BL\/BLIs in patients with BSI due to ESBL-Escherichia coli was not associated with a statistically significant difference in mortality (RR, 1.014; 95% CI, 0.491\u20132.095; I2 = 62.5%; P = .046), compared with the use of empiric carbapenems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These data do not support the wide use of carbapenems as empiric therapy, and BL\/BLIs might be effective agents for initial\/empiric therapy for patients with BSI caused by likely ESBL-PE, and especially ESBL-E coli.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ofid\/ofx099","type":"journal-article","created":{"date-parts":[[2017,5,16]],"date-time":"2017-05-16T05:59:35Z","timestamp":1494914375000},"source":"Crossref","is-referenced-by-count":42,"title":["Comparison Between Carbapenems and \u03b2-Lactam\/\u03b2-Lactamase Inhibitors in the Treatment for Bloodstream Infections Caused by Extended-Spectrum \u03b2-Lactamase-Producing Enterobacteriaceae: A Systematic Review and Meta-Analysis"],"prefix":"10.1093","volume":"4","author":[{"given":"Maged","family":"Muhammed","sequence":"first","affiliation":[{"name":"Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myrto Eleni","family":"Flokas","sequence":"additional","affiliation":[{"name":"Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marios","family":"Detsis","sequence":"additional","affiliation":[{"name":"Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michail","family":"Alevizakos","sequence":"additional","affiliation":[{"name":"Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftherios","family":"Mylonakis","sequence":"additional","affiliation":[{"name":"Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,5,16]]},"reference":[{"key":"2020081005274217200_CIT0001","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1128\/CMR.18.4.657-686.2005","article-title":"Extended-spectrum beta-lactamases: a clinical update","volume":"18","author":"Paterson","year":"2005","journal-title":"Clin Microbiol Rev"},{"key":"2020081005274217200_CIT0002","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1056\/NEJMra041359","article-title":"The new beta-lactamases","volume":"352","author":"Jacoby","year":"2005","journal-title":"N Engl J 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