Oral β-Lactam Antibiotics vs Fluoroquinolones or Trimethoprim-Sulfamethoxazole for Definitive Treatment of Enterobacterales Bacteremia From a Urine Source
| Autor: | Vanessa Stevens, Karim Khader, Jesse Sutton, Emily S Spivak, Nai-Chung N Chang, Tristan T Timbrook |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_class Antibiotics Anti-Infective Agents Urinary beta-Lactams Cohort Studies Interquartile range Drug Resistance Multiple Bacterial Internal medicine Trimethoprim Sulfamethoxazole Drug Combination medicine Humans Aged Retrospective Studies Original Investigation Aged 80 and over business.industry Research Sulfamethoxazole Enterobacteriaceae Infections Retrospective cohort study General Medicine Middle Aged bacterial infections and mycoses medicine.disease Trimethoprim Anti-Bacterial Agents Online Only Infectious Diseases Relative risk Bacteremia Urinary Tract Infections Female business Cohort study medicine.drug |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| DOI: | 10.1001/jamanetworkopen.2020.20166 |
| Popis: | Key Points Question Are mortality and recurrent bacteremia different for patients who receive oral β-lactam antibiotics vs fluoroquinolones or trimethoprim-sulfamethoxazole for definitive treatment of Enterobacterales bacteremia from a urinary source? Findings In this cohort study of 4089 patients, the relative risk of recurrent bacteremia at 30 days was not significantly higher with oral β-lactam antibiotics than with fluoroquinolones or trimethoprim-sulfamethoxazole, and the absolute risk difference was small. Meaning This study suggests that oral β-lactam antibiotics may be a reasonable definitive treatment when alternatives are limited by resistance or adverse effects. Importance Oral β-lactam antibiotics are traditionally not recommended to treat Enterobacterales bacteremia because of concerns over subtherapeutic serum concentrations, but there is a lack of outcomes data, specifically after initial treatment with parenteral antibiotics. Given the limited data and increasing limitations of fluoroquinolones or trimethoprim-sulfamethoxazole (TMP-SMX), oral β-lactam antibiotics may be a valuable additional treatment option. Objective To compare definitive therapy with oral β-lactam antibiotics vs fluoroquinolones or TMP-SMX for Enterobacterales bacteremia from a suspected urine source. Design, Setting, and Participants A retrospective cohort study was conducted from January 1, 2007, to September 30, 2015, at 114 Veterans Affairs hospitals among 4089 adults with Escherichia coli, Klebsiella spp, or Proteus spp bacteremia and matching urine culture results. Additional inclusion criteria were receipt of active parenteral antibiotic(s) followed by conversion to an oral antibiotic. Exclusion criteria were previous Enterobacterales bacteremia, urologic abscess, or chronic prostatitis. Data were analyzed from April 15, 2019, to July 26, 2020. Exposures Conversion of therapy to an oral β-lactam antibiotic vs fluoroquinolones or TMP-SMX after 1 to 5 days of parenteral antibiotics. Main Outcomes and Measures The main outcome was a composite of either 30-day all-cause mortality or 30-day recurrent bacteremia. Propensity-based overlap weights were used to adjust for differences between groups. Log binomial regression models were used to estimate adjusted relative risks (aRRs) and adjusted risk differences (aRDs). Results Of the 4089 eligible patients (3731 men [91.2%]; median age, 71 years [interquartile range, 63-81 years]), 955 received an oral β-lactam antibiotic, and 3134 received fluoroquinolones or TMP-SMX. The primary outcome occurred for 42 patients (4.4%) who received β-lactam antibiotics and 94 patients (3.0%) who received fluoroquinolones or TMP-SMX (aRD, 0.99% [95% CI, −0.42% to 2.40%]; aRR, 1.31 [95% CI, 0.87-1.95]). Mortality rates were 3.0% (n = 29) for patients receiving β-lactam antibiotics vs 2.6% (n = 82) for those receiving fluoroquinolones or TMP-SMX (aRD, 0.06% [95% CI, −1.13% to 1.26%]; aRR, 1.02 [95% CI, 0.67-1.56]). Recurrent bacteremia rates were 1.5% (n = 14) among those receiving β-lactam antibiotics vs 0.4% (n = 12) among those receiving fluoroquinolones or TMP-SMX (aRD, 1.03% [95% CI, 0.24%-1.82%]; aRR, 3.43 [95% CI, 0.42-27.90]). Conclusions and Relevance In this cohort study of adults with E coli, Klebsiella spp, or Proteus spp bacteremia from a suspected urine source, the relative risk of recurrent bacteremia was not significantly higher with β-lactam antibiotics compared with fluoroquinolones or TMP-SMX, and the absolute risk and risk difference were small (ie This cohort study compares definitive therapy with oral β-lactam antibiotics vs fluoroquinolones or trimethoprim-sulfamethoxazole after 1 to 5 days of parenteral antibiotics for Enterobacterales bacteremia from a suspected urine source. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|