Seven-day antibiotic therapy for Enterobacterales bacteremia in high-risk neutropenic patients: toward a new paradigm.

Autor: Herrera F; Infectious Diseases Section, Internal Medicine Department, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Av. Galván 4102 (C1431), Buenos Aires, Argentina. fabian1961@gmail.com., Torres D; Infectious Diseases Section, Internal Medicine Department, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Av. Galván 4102 (C1431), Buenos Aires, Argentina., Laborde A; Infectious Diseases Service, Fundación Para Combatir La Leucemia (FUNDALEU), Buenos Aires, Argentina., Jordán R; Infectious Diseases Service, Hospital Británico de Buenos Aires, Buenos Aires, Argentina., Tula L; Infectious Diseases Service, Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina., Mañez N; Infectious Diseases Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Pereyra ML; Infectious Diseases Service, Hospital Universitario Austral, Buenos Aires, Argentina., Suchowiercha N; Infectious Diseases Service, Hospital Interzonal General de Agudos (HIGA) Gral. San Martín de La Plata, Buenos Aires, Argentina., Berruezo L; Infectious Diseases Service, Hospital Interzonal General de Agudos (HIGA), Prof. Dr. Rodolfo Rossi de La Plata, Buenos Aires, Argentina., Gudiol C; Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Barcelona, España., Ibáñez MLG; Infectious Diseases Service, Fundación Para Combatir La Leucemia (FUNDALEU), Buenos Aires, Argentina., Eusebio MJ; Infectious Diseases Service, Hospital Británico de Buenos Aires, Buenos Aires, Argentina., Lambert S; Infectious Diseases Service, Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina., Barcán L; Infectious Diseases Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Rossi IR; Infectious Diseases Service, Hospital Interzonal General de Agudos (HIGA) Gral. San Martín de La Plata, Buenos Aires, Argentina., Nicola F; Microbiology Laboratory, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina., Pennini M; Microbiology Laboratory, Centro de Estudios Infectológicos (CEI) Dr. Stamboulian, Buenos Aires, Argentina., Monge R; Microbiology Service, Hospital Británico de Buenos Aires, Buenos Aires, Argentina., Blanco M; Microbiology Laboratory, Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina., Visús M; Bacteriology Laboratory, Central Laboratory, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Reynaldi M; Microbiology Laboratory, Hospital Interzonal General de Agudos (HIGA), Gral. San Martín de La Plata, Buenos Aires, Argentina., Carbone R; Bacteriology Laboratory, Hospital Interzonal General de Agudos (HIGA) Prof. Dr. Rodolfo Rossi de La Plata, Buenos Aires, Argentina., Pasterán F; Antimicrobials Service, INEI-ANLIS Dr. Carlos Malbrán, Buenos Aires, Argentina., Corso A; Antimicrobials Service, INEI-ANLIS Dr. Carlos Malbrán, Buenos Aires, Argentina., Rapoport M; Antimicrobials Service, INEI-ANLIS Dr. Carlos Malbrán, Buenos Aires, Argentina., Carena AA; Infectious Diseases Section, Internal Medicine Department, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Av. Galván 4102 (C1431), Buenos Aires, Argentina.
Jazyk: angličtina
Zdroj: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology [Eur J Clin Microbiol Infect Dis] 2024 Sep; Vol. 43 (9), pp. 1741-1751. Date of Electronic Publication: 2024 Jul 03.
DOI: 10.1007/s10096-024-04885-w
Abstrakt: Purpose: Data on short courses of antibiotic therapy for Enterobacterales bacteremia in high-risk neutropenic patients are limited. The aim of the study was to describe and compare the frequency of bacteremia relapse, 30-day overall and infection-related mortality, Clostridiodes difficile infection and length of hospital stay since bacteremia among those who received antibiotic therapy for 7 or 14 days.
Methods: This is a multicenter, prospective, observational cohort study in adult high-risk neutropenic patients with hematologic malignancies or hematopoietic stem cell transplant and monomicrobial Enterobacterales bacteremia. They received appropriate empirical antibiotic therapy, had a clinical response within 7 days, and infection source control. Clinical, epidemiological and outcomes variables were compared based on 7 or 14 days of AT.
Results: Two hundred patients were included (100, 7-day antibiotic therapy; 100, 14-day antibiotic therapy). Escherichia coli was the pathogen most frequently isolated (47.5%), followed by Klebsiella sp. (40.5%). Among those patients that received 7-day vs. 14-day antibiotic course, a clinical source of bacteremia was found in 54% vs. 57% (p = 0.66), multidrug-resistant Enterobacterales isolates in 28% vs. 30% (p = 0.75), and 40% vs. 47% (p = 0.31) received combined empirical antibiotic therapy. Overall mortality was 3% vs. 1% (p = 0.62), in no case related to infection; bacteremia relapse was 7% vs. 2% (p = 0.17), and length of hospital stay since bacteremia had a median of 9 days (IQR: 7-15) vs. 14 days (IQR: 13-22) (p =  < 0.001).
Conclusions: These data suggest that seven-day antibiotic therapy might be adequate for patients with high-risk neutropenia and Enterobacterales bacteremia, who receive appropriate empirical therapy, with clinical response and infection source control.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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