NAHTIGAL KM, LUSA L, TERZIĆ S, MUELLER-PREMRU M, PIRŠ M, et al. (2019) Could we Spare Carbapenems for Empiric Therapy in ESBL-Enterobacteriaceae Colonized Elderly with Community- Onset Sepsis?. J Geriatr Med Gerontol 5:059.


© 2019 NAHTIGAL KM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

RESEARCH ARTICLE | OPEN ACCESS DOI: 10.23937/2469-5858/1510059

Could we Spare Carbapenems for Empiric Therapy in ESBL-Enterobacteriaceae Colonized Elderly with Community-Onset Sepsis?

NAHTIGAL KLEVIŠAR Mirijam1, LUSA Lara2,3, TERZIĆ Sara1, MUELLER-PREMRU Manica4, PIRŠ Mateja4 and STUPICA Daša1,5*

1Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia

2Department of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Slovenia

3Faculty of Medicine, Institute for Biostatistics and Medical Informatics, University of Ljubljana, Slovenia

4Faculty of Medicine, Institute of Microbiology and Immunology, Slovenia

5Faculty of Medicine, University of Ljubljana, Slovenia


The preference for empiric antibiotic therapy with carbapenems over non-carbapenems in all extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) colonized patients with sepsis warrants further investigation from an ecologic perspective; even more so in the elderly (≥ 65 years) because the proportion of ESBL-E in adults increases with patients' age. In this retrospective observational study, enrolling 547 ESBL-E colonized elderly patients with community-onset sepsis, hospitalized at a single medical centre from 2011 to 2015, the positive predictive value of ESBL-E faecal colonization for ESBL-E aetiology of sepsis was significantly higher (66.1%) when sepsis originated from a urinary tract infection than from a respiratory tract infection (26.1%), other known origins (31.6%), or an unidentified origin (13.0%). Carbapenems were prescribed empirically in 145 patients (26.5%), and 402 received non-carbapenem antibiotics. Univariate analysis suggested a higher 30-day mortality in the non-carbapenem vs. carbapenem group. However, the estimated association was smaller and not significant (OR = 1.1, 95% CI, 0.6-1.9, P = 0.62) in the multiple regression analysis adjusted for age, sex, Charlson comorbidity index score, and severity, origin or aetiology of sepsis. Therefore, carbapenem-sparing empiric therapy seems appropriate for non-critically ill elderly ESBL-E carriers with community-onset sepsis, even more so when sepsis originates outside urinary tract.