Impact of Empirical Antibiotic Regimens on Mortality in Neutropenic Patients with Bloodstream Infection Presenting with Septic Shock
| Autor: | Alex Soriano, Júlia Laporte-Amargós, Mariana Chumbita, Jordi Carratalà, Maria Condom, Carolina Garcia-Vidal, Andrea Ladino, María Suárez-Lledó, Carlota Gudiol, Francesc Marco, Enric Sastre, Ignacio Grafia, Josep Mensa, Alba Bergas, Cristina Helguera, José Antonio Martínez, Adaia Albasanz-Puig, Pedro Castro, Nicole Garcia-Pouton, Xavier Durà, Carlota Jordan, Pedro Puerta-Alcalde |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
Multivariate analysis Combination therapy medicine.drug_class Antibiotics Bacteremia Clinical Therapeutics Internal medicine Bloodstream infection Sepsis medicine Humans Pharmacology (medical) Prospective Studies Aged Retrospective Studies Pharmacology business.industry Septic shock Acute kidney injury Retrospective cohort study bacterial infections and mycoses medicine.disease Shock Septic Anti-Bacterial Agents Infectious Diseases Amikacin business medicine.drug |
| Zdroj: | Antimicrob Agents Chemother |
| Popis: | We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. A multicenter retrospective study (2010 to 2019) of two prospective cohorts compared BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Of 1,563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% versus 15%, P 70 years (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.2 to 4.7), IEAT for Candida spp. or Gram-negative bacilli (OR, 3.8; 95% CI, 1.3 to 11.1), acute kidney injury (OR, 2.6; 95% CI, 1.4 to 4.9), and amikacin as the only active antibiotic (OR, 15.2; 95% CI, 1.7 to 134.5) were independent risk factors for mortality, while the combination of β-lactam and amikacin was protective (OR, 0.32; 95% CI, 0.18 to 0.57). Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes. |
| Databáze: | OpenAIRE |
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