Objective: Carbapenems are considered treatment of choice for bacteremia caused by potential AmpC-producing bacteria, including Enterobacter spp. We aimed to compare mortality following carbapenem vs. alternative antibiotics for the treatment of Enterobacter spp. bacteremia. Patients and Methods: We conducted a retrospective study in two centers in Israel. We included hospitalized patients with Enterobacter bacteremia treated with third-generation cephalosporins (3GC), piperacillin/tazobactam, quinolones, or carbapenem monotherapy as the main antibiotic in the first week of treatment, between 2010 and 2017. Cefepime was excluded due to nonavailability during study years. The primary outcome was 30-day all-cause mortality. Univariate and multivariate analyses were conducted, introducing the main antibiotic as an independent variable. Results: Two hundred seventy-seven consecutive patients were included in the analyses. Of these, 73 were treated with 3GC, 39 with piperacillin/tazobactam, 104 with quinolones, and 61 with carbapenems. All-cause 30-day mortality was 16% (45 patients). The type of antibiotics was not significantly associated with mortality on univariate or multivariate analyses. With carbapenems as reference, adjusted odds ratios (ORs) for mortality were 0.708, 95% confidence interval (CI) 0.231–2.176 with 3GC; OR 1.172, 95% CI 0.388–3.537 with piperacillin/tazobactam; and OR 0.586, 95% CI 0.229–1.4 with quinolones. The main antibiotic was not associated with repeated growth of Entrobacter spp. in blood cultures or other clinical specimens. Resistance development was observed with 3GC and piperacillin/tazobactam. Conclusions: Carbapenem treatment was not advantageous to alternative antibiotics, including 3GC, among patients with Enterobacter spp. bacteremia in an observational study.

Purpose: Due to the low incidence of male microprolactinoma, there is a paucity of data in the literature regarding its management. Our aim was to investigate the long-term outcomes of cabergoline treatment in men with microprolactinoma. Methods: In this single-center retrospective cohort study, we reviewed patient’s records at prolactinoma diagnosis, following cabergoline discontinuation (if occurred), and at the last clinic visit. We collected all available clinical data, laboratory tests, and pituitary magnetic resonance imaging. We report response rates, gonadal axis recovery, and outcomes following cabergoline discontinuation. Results: The study cohort included 47 men with microprolactinoma [age at diagnosis 45.6 ± 17.6 years; median prolactin 70.0 ng/ml (IQR 51.0–103.4); low testosterone, 34 men (72.3%); adenoma diameter 5.6 ± 2.0 mm; median follow-up 7.1 years (IQR 3.5–10.4)]. Forty-two patients (89.4%) achieved normal prolactin levels within a median treatment time of 4.0 months (IQR 3.0–5.5) and had normal testosterone at last clinic visit. Five men (10.6%) did not achieve prolactin normalization, of whom 3 men remained hypogonadal. Mild side effects occurred in 4.3% of patients and disappeared with dose reduction. Thirteen men that achieved normal prolactin attempted drug discontinuation, but only 5 remained with normoprolactinemia. Men who maintained normal prolactin levels were treated longer with cabergoline [median treatment of 10 years (IQR 4.6–10.3) vs 2.0 years (IQR 1.5–3.2); p < 0.01]. Conclusions: Ninety percent of men harboring microprolactinoma achieved normoprolactinemia and subsequent testosterone normalization with cabergoline treatment. Men that discontinued cabergoline after prolonged prolactin suppression (>5 years) achieved sustained remission. These findings assist informed decision-making, between medical and surgical treatment.