Combination treatments are effective for high risk patients with a serious bloodstream infection, according to the results of a major European-led trial.
The results, unveiled at a conference yesterday, showed that high risk patients were helped but low-risk patients gained no advantage from multiple drug treatments for the carbapenemase-producing Enterobacteriaceae - CPE.
The finding was one of several from the INCREMENT study reported to the European Congress of Clinical Microbiology and Infectious Diseases in in Vienna, Austria. They were also reported in The Lancet.
The study involved 37 hospitals in 11 countries and 437 patients with the infection.
Researcher Professor Jesús Rodríguez-Baño, of the University Hospital Virgen Macarena (Seville, Spain), said: 'Contrary to present recommendations, combination therapy can be avoided in a substantial proportion of patients with bloodstream infections due to CPE.
'This helps to avoid the problems that can be associated with combination therapy, such as a higher risk of adverse side effects, the development of resistance by the infection-causing bacteria to more antimicrobials, and the higher cost.
'We hope that, as a result of these findings, clinicians will be able to evaluate patients better so that only those at high risk will be given combination therapy.'
A second result from the study suggested an improved strategy for treating extended-spectrum beta-lactamase producing Enterobacteriaceae, which are usually resistant to cephalosporins, the conference heard. This involved avoiding using carbapenems and using other drugs as the first-line treatment.
This arm of the study involved 855 patients treated between 2004 and 2012.
Researcher Dr Zaira Palacios Baena, of the Hospital Universitario Virgen Macarena (Seville, Spain), said: 'We found that even if we treated patients with antimicrobial drugs that proved to be inactive against the bug that was causing the infection, it did not increase death rates if we take into account their underlying risk of death and if we switch to a drug that is active against the infection as soon as we know which one will work.
'Nowadays, with the evolution of technology in the field of microbiology, we can know the susceptibility of a microorganism within 24 hours and then we can start using the right, targeted active treatment. This means that we do not have to start treating patients immediately with carbapenems, but can try out other drugs first before switching to an active antimicrobial, that is not necessarily a carbapenem, if the first drug doesn’t work.'
Dr Baena added: 'There is no consistent evidence about the use of different regimens of treatments for bloodstream infections due to extended-spectrum beta-lactamase producing Enterobacteriaceae.
'We wanted to assess the impact of starting treatment with drugs that were thought likely to be active against the infection - but before doctors had identified the precise microorganism causing the infection and which drugs it would be susceptible to.'
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