Early antibiotic de-escalation in patients with severe infections due to bloodstream infection by enterobacterales: A post hoc analysis of a prospective multicentre cohort.

Autor: Escrihuela-Vidal F; Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain., Palacios-Baena ZR; Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS)/CSIC; Hospital Universitario Virgen Macarena, and Departamento de Medicina, Universidad de Sevilla, Seville, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain., Agirre JG; Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bizkaia, Spain., Pérez-Rodríguez MT; Complejo Hospitalario Universitario de Vigo, Galicia Sur Health Research Institute, Vigo, Spain., Reguera Iglesias JM; Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain., Cuquet Pedragosa J; Departamento de Medicina Interna, Hospital Universitario de Granollers, Granollers, Spain., Sánchez Gómez L; Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario de Burgos, Burgos, Spain., Boix-Palop L; Servicio de Enfermedades Infecciosas, Hospital Universitari Mútua de Terrassa, Barcelona, Spain., Bahamonde Carrasco A; Departamento de Medicina Interna, Hospital de El Bierzo, Ponferrada, Spain., Natera-Kindelán C; Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain., Fernández-Suárez J; Unidad de Microbiología, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, Oviedo., Jover-Sáenz A; Unidad Funcional de Infecciones Nosocomiales, Hospital Arnau de Vilanova, Lérida, Spain., Smithson Amat A; Unidad de Medicina Interna, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Spain., Del Arco Jiménez A; Grupo Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Costa del Sol, Marbella, Málaga, Spain., Sánchez Calvo JM; Hospital Universitario de Jerez, Jerez de la Frontera, Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Universidad de Cádiz, Cadiz, Spain., Martín-Aspas A; Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Facultad de Medicina, Hospital Universitario Puerta del Mar, Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Universidad de Cádiz, Cadiz, Spain., Martínez Pérez-Crespo PM; Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain., López-Hernández I; Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS)/CSIC; Hospital Universitario Virgen Macarena, and Departamento de Medicina, Universidad de Sevilla, Seville, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain., Rodríguez-Baño J; Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS)/CSIC; Hospital Universitario Virgen Macarena, and Departamento de Medicina, Universidad de Sevilla, Seville, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain., López-Cortés LE; Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS)/CSIC; Hospital Universitario Virgen Macarena, and Departamento de Medicina, Universidad de Sevilla, Seville, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: llopez14@us.es.
Jazyk: angličtina
Zdroj: International journal of antimicrobial agents [Int J Antimicrob Agents] 2024 Nov; Vol. 64 (5), pp. 107317. Date of Electronic Publication: 2024 Sep 02.
DOI: 10.1016/j.ijantimicag.2024.107317
Abstrakt: Background: Data about antibiotic de-escalation in sepsis associated with the bloodstream and caused by Enterobacterales are scarce. The objectives of this study are to identify factors associated with early de-escalation and to analyse the impact of de-escalation on mortality in patients with Enterobacterales bloodstream infection (BSI) with a Sequential Organ Failure Assessment (SOFA) score ≥ 2.
Methods: A prospective, multicentre cohort study was performed including episodes of BSI due to Enterobacterales and a SOFA score ≥ 2 who were receiving an active antipseudomonal β-lactam; the isolate should be susceptible to at least 1 narrower-spectrum antibiotic. Variables associated with de-escalation were identified using logistic binary regression. The association of de-escalation with 30-day mortality was investigated. Confounding was controlled by calculating a propensity score used as covariate, as matching variable, and for inverse probability treatment weighting.
Results: Of the 582 patients included, de-escalation was performed in 311 (53.4%). Neutropenia (adjusted odds ratio [aOR] = 0.37; 95% confidence interval [95% CI] = 0.18-0.75), central venous catheter (aOR = 0.52; 95% CI = 0.32-0.83), and extended-spectrum β-lactamase (ESBL)-producing isolate (aOR = 0.28; 95% CI = 0.17-0.48) were negatively associated with de-escalation, and urinary tract source was positively associated (aOR = 2.27; 95% CI = 1.56-3.33). The 30-day mortality was 6.8% (21 patients) in de-escalated patients and 14.4% (39) in not de-escalated patients (relative risk, 0.63; 95% CI = 0.44-0.89). In multivariate analysis including the propensity score, de-escalation was not associated with mortality (AOR = 0.98; 95% CI = 0.39-2.47) and was protective in the case of urinary or biliary tract source (AOR = 0.31, 95% CI = 0.09-1.06). Matched and inverse probability treatment weighting analysis showed similar results.
Conclusions: These results suggest that early de-escalation from antipseudomonal β-lactams is safe in patients with Enterobacterales bacteremia and SOFA ≥ 2.
(Copyright © 2024. Published by Elsevier Ltd.)
Databáze: MEDLINE
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