Meropenem versus Cefotaxime and Ampicillin as Empirical Antibiotic Treatment in Adult Bacterial Meningitis: a Quality Registry Study, 2008 to 2016.
| Autor: | Brink M; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden magnus.brink@vgregion.se.; Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden., Glimåker M; Division of Infectious Diseases, Department of Medicine, Karolinska Institute, Solna, Sweden.; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden., Sjölin J; Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden., Naucler P; Division of Infectious Diseases, Department of Medicine, Karolinska Institute, Solna, Sweden.; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. |
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| Jazyk: | angličtina |
| Zdroj: | Antimicrobial agents and chemotherapy [Antimicrob Agents Chemother] 2019 Oct 22; Vol. 63 (11). Date of Electronic Publication: 2019 Oct 22 (Print Publication: 2019). |
| DOI: | 10.1128/AAC.00883-19 |
| Abstrakt: | Cefotaxime, alone or with ampicillin, is frequently used in empirical treatment of acute bacterial meningitis (ABM). Meropenem is a less extensively investigated alternative. The aim of the study was to investigate the effects of empirical treatment with meropenem compared to cefotaxime plus ampicillin on outcome in ABM. The study was based on data from the Swedish quality register for ABM collected between January 2008 and December 2016. Propensity score matching was performed to adjust for baseline differences between the groups. Mortality within 30 days was the primary outcome. The treatment regimens of interest were administered to 623 patients; 328 were given cefotaxime plus ampicillin whereas 295 received meropenem. Using propensity score matching, the 30-day mortality rates were 3.2% in the cefotaxime plus ampicillin group and 3.6% in the meropenem group. For matched cases, the odds ratio (OR) for 30-day mortality for meropenem versus cefotaxime plus ampicillin was 1.15 (confidence interval [CI], 0.41 to 3.22; P = 0.79). The OR for 90-day mortality was 1.47 (CI, 0.62 to 3.52; P = 0.38) and for unfavorable outcome was 1.10 (CI, 0.75 to 1.63; P = 0.62). The findings of our study indicate that meropenem is an effective empirical treatment option for adults with community-acquired ABM. However, to spare carbapenems, guidelines should continue to recommend third-generation cephalosporins as an empirical treatment for the majority of patients with ABM. (Copyright © 2019 American Society for Microbiology.) |
| Databáze: | MEDLINE |
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