Evidence map›Paper›PMID 38679036›Full record

ArticleThe Lancet. Infectious diseases2024

Carbapenem use in extended-spectrum cephalosporin-resistant Enterobacterales infections in US hospitals and influence of IDSA guidance: a retrospective cohort study.

Morgan K Walker, Guoqing Diao, Sarah Warner, Ahmed Babiker, Maniraj Neupane, Jeffrey R Strich, Christina Yek, Sameer S Kadri, National Institutes of Health Antimicrobial Resistance Outcomes Research Initiative (NIH–ARORI)

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PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Infectious diseases, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Trial
  2. Article
  3. Research Progress on perinatalFrontiers in microbiology · 2026
    Review
  4. Article
  5. Article
  6. Article
  7. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Morgan K WalkerCritical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA; Critical Care Medicine Branch, National Heart Lung and Blood Institute, Bethesda, MD, USA.
Guoqing DiaoDepartment of Biostatistics, George Washington University, Washington, DC, USA.
Sarah WarnerCritical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA; Critical Care Medicine Branch, National Heart Lung and Blood Institute, Bethesda, MD, USA.
Ahmed BabikerEmory University School of Medicine, Atlanta, GA, USA.
Maniraj NeupaneCritical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA; Critical Care Medicine Branch, National Heart Lung and Blood Institute, Bethesda, MD, USA.
Jeffrey R StrichCritical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA; Critical Care Medicine Branch, National Heart Lung and Blood Institute, Bethesda, MD, USA.
Christina YekCritical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA; Critical Care Medicine Branch, National Heart Lung and Blood Institute, Bethesda, MD, USA.
Sameer S KadriCritical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA; Critical Care Medicine Branch, National Heart Lung and Blood Institute, Bethesda, MD, USA. Electronic address: sameer.kadri@nih.gov.
National Institutes of Health Antimicrobial Resistance Outcomes Research Initiative (NIH–ARORI)

Funding

Antibacterial Resistance Leadership Group (ARLG)UM1AI104681 · NIAID · DUKE UNIVERSITY · PI Vance G. Fowler, Henry F HENRY CHAMBERS · 2013 to 2026
$180.8M
Big Data- Epidemiology of Antimicrobial ResistanceZIACL090046 · CLC · CLINICAL CENTER · PI KADRI, SAMEER · 2017 to 2025
$0k
Intramural NIH HHS ZIA CL090046NIAID NIH HHS UM1 AI104681
6 · The paper itself

Abstract

backgroundDisparate and rapidly changing practice recommendations from major professional infectious diseases societies for managing non-severe infections caused by extended-spectrum β-lactamase-producing Enterobacterales might hamper carbapenem stewardship. We aimed to understand the real-world management of extended-spectrum cephalosporin-resistant (ECR) Enterobacterales infections in US hospitals and factors influencing preference for carbapenems over alternative treatments.

methodsThis retrospective cohort study included adults (aged ≥18 years) admitted to hospital with ECR Enterobacterales infections in the PINC AI database. Antibiotic regimens were assessed during empirical and targeted treatment periods and by infection severity and site. Likelihood of receiving targeted carbapenems over time and before or after initial release of the Infectious Diseases Society of America (IDSA) guidance on Sept 8, 2020, was established with generalised estimating equations controlling for patient, hospital, and temporal confounders.

findingsBetween Jan 1, 2018, and Dec 31, 2021, 30 041 inpatient encounters with ECR Enterobacterales infections were identified at 168 US hospitals, of which 16 006 (53·3%) encounters were in women and 14 035 (46·7%) were in men, with a mean age of 67·3 years (SD 15·1). Although few patients received carbapenems empirically (5324 [17·7%] of 30 041), many did so as targeted treatment (17 518 [58·3%] of 30 041), including subgroups of patients without septic shock (3031 [45·6%] of 6651) and patients with urinary tract infections without septic shock (1845 [46·8%] of 3943) in whom specific narrower-spectrum alternatives were active. Transitions from non-carbapenem to carbapenem antibiotics occurred most often on the day that the ECR phenotype was reported, regardless of illness severity. Carbapenems were the predominant choice to treat ECR Enterobacterales infections over time (adjusted odds ratio 1·00 [95% CI 1·00-1·00]), with no additional immediate change (1·07 [0·95-1·20]) or sustained change (0·99 [0·98-1·00]) after IDSA guidance release.

interpretationHigh carbapenem use in targeting non-severe ECR Enterobacterales infections in US hospitals predates 2020 IDSA guidance and has persisted thereafter. Efforts to increase awareness and implementation of recommendations among clinicians to use carbapenem-sparing alternatives in ECR Enterobacterales infections might decrease global carbapenem selective pressure.

fundingUS National Institutes of Health Intramural Research Program, National Institute of Allergy and Infectious Diseases, and US Food and Drug Administration.

Indexed as

Anti-Bacterial AgentsCarbapenemsEnterobacteriaceae InfectionsAdultAgedAntimicrobial StewardshipCephalosporin ResistanceCephalosporinsEnterobacteriaceaeFemaleHospitalsHumansMaleMiddle AgedPractice Guidelines as TopicRetrospective StudiesAnti-Bacterial AgentsCarbapenemsCephalosporins

Identifiers

PMID38679036
PMCPMC11283355

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.