Mortality outcomes of extended-spectrum β-lactamase in bacteremia with carbapenems and other antibiotics: A systematic review.

Abstract

The study examined the mortality outcomes of extended-spectrum β-lactamase (ESBL)-producing bacteria in Enterobacteriaceae, specifically Klebsiella pneumoniae and Escherichia coli, and reviewed evidence on carbapenem-sparing regimens to avoid carbapenem use in treating ESBL infections, focusing on patients with bacteremia. This study analyzed 30-day all-cause mortality outcomes in adult patients over 18 years treated with carbapenem compared to other antibiotics for bloodstream infections caused by ESBL using Scopus, PubMed, and Sage Journal databases from 2015 to 2024, using pooled risk ratios and 95% confidence intervals for all outcomes. Eight studies found no significant differences between groups receiving carbapenems and other antibiotics. However, carbapenems were found to have a higher 30-day all-cause mortality rate than comparative antibiotics for ESBL in bacteremia. Two studies reported lower 30-day all-cause mortality rates when using carbapenems. There was no significant correlation between antibiotic use and ESBL-related mortality in bacteremia patients. Most carbapenem therapy users had a higher mortality rate than those using other antibiotics; however, the difference was not statistically significant.