Temocillin vs Meropenem for the Targeted Treatment of Bacteraemia Resistant to Third Gen Cephalosporins

Inclusion Criteria:

• Adult patients with monomicrobial bacteremia due to Enterobacteriaceae showingresistance to cefotaxime, ceftriaxone (MIC >2 mg/L) and/or ceftazidime (MIC >4mg/L), and sensible to temocillin (MIC ≤8 mg/L, except in bacteremia only of urinaryorigin, for which the criterion is MIC ≤16 mg/L ) and meropenem (MIC ≤2 mg/L).

Patients with polymicrobial bacteremia caused by more than one Enterobacteriaceae species may also be included, provided at least one of them is resistant to third-generation cephalosporins, and both are susceptible to meropenem and temocillin.

• Duration of intravenous treatment is planned to be at least 4 days fromrandomization, or 3 days if the empirical treatment prior to randomization wasactive.

• The patient signed informed consent form.

• Potentially fertile patients must have a negative pregnancy test.

Exclusion Criteria:

• <18 years

• Pregnancy

• Breastfeeding

• Terminal condition, with life expectancy of less than 30 days, or palliative care ,such that no actions will be taken to control the source of infection if necessary.Patients receiving palliative care with a life expectancy greater than 30 days maybe included if source control is not necessary or, if necessary, will be carriedout.

• Allergy to betalactams

• Polymicrobial bacteraemia (except when the other microorganism is considered acontaminant, (e.g. coagulase-negative staphylococci or diphtheroids in a singleblood culture, or in cases where more than one Enterobacteriaceae species isisolated, provided that at least one isolate is resistant to third-generationcephalosporins and both are susceptible to meropenem and temocillin).

• Infections typically needing prolonged >14 days of therapy (e.g., endocarditis,prosthetic joint infection, vascular graft infection, empyema, chronic prostatitis)or meningitis. Patients who initially do not have a confirmed diagnosis of theseinfections may be included; if the diagnosis is made subsequently, the patient maybe kept in the trial at the discretion of the investigator, establishing theduration of treatment that he considers necessary.

• Active empirical treatment> 96 hours after initial blood culture extraction

• Delay in inclusion> 48 h

• Recruited in another clinical trial with active treatment

• Peritoneal dialysis or continuous hemofiltration