Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species
| Autor: | Jenna Swindler, Kathey Fulton Rumley, Majdi N. Al-Hasan, V. Paul DiMondi, Shawn H. MacVane, Scott Kincaid, Kayla R. Stover, Virginia Fleming, Kelly E. Pillinger, Christopher M. Bland, Trisha Branan, P. Brandon Bookstaver, Brian Odle, Caroline Derrick, Zhiqiang K. Lu, S. Travis King, Sandy Estrada, David Cluck, Julie Ann Justo, Brad Crane, Bruce M Jones, Benjamin B Britt |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty medicine.drug_class Urinary system 030106 microbiology Cephalosporin Antibiotics Biochemistry Microbiology Article Sepsis sepsis beta-lactamases 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Pharmacology (medical) AmpC 030212 general & internal medicine General Pharmacology Toxicology and Pharmaceutics bacteremia biology business.industry lcsh:RM1-950 Retrospective cohort study Enterobacter biology.organism_classification medicine.disease Infectious Diseases lcsh:Therapeutics. Pharmacology Bacteremia cephalosporins carbapenems business Cohort study |
| Zdroj: | Antibiotics Antibiotics, Vol 9, Iss 254, p 254 (2020) Volume 9 Issue 5 |
| ISSN: | 2079-6382 |
| Popis: | Objectives: There is debate on whether the use of third-generation cephalosporins (3GC) increases the risk of clinical failure in bloodstream infections (BSIs) caused by chromosomally-mediated AmpC-producing Enterobacterales (CAE). This study evaluates the impact of definitive 3GC therapy versus other antibiotics on clinical outcomes in BSIs due to Enterobacter, Serratia, or Citrobacter species. Methods: This multicenter, retrospective cohort study evaluated adult hospitalized patients with BSIs secondary to Enterobacter, Serratia, or Citrobacter species from 1 January 2006 to 1 September 2014. Definitive 3GC therapy was compared to definitive therapy with other non-3GC antibiotics. Multivariable Cox proportional hazards regression evaluated the impact of definitive 3GC on overall treatment failure (OTF) as a composite of in-hospital mortality, 30-day hospital readmission, or 90-day reinfection. Results: A total of 381 patients from 18 institutions in the southeastern United States were enrolled. Common sources of BSIs were the urinary tract and central venous catheters (78 (20.5%) patients each). Definitive 3GC therapy was utilized in 65 (17.1%) patients. OTF occurred in 22/65 patients (33.9%) in the definitive 3GC group vs. 94/316 (29.8%) in the non-3GC group (p = 0.51). Individual components of OTF were comparable between groups. Risk of OTF was comparable with definitive 3GC therapy vs. definitive non-3GC therapy (aHR 0.93, 95% CI 0.51&ndash 1.72) in multivariable Cox proportional hazards regression analysis. Conclusions: These outcomes suggest definitive 3GC therapy does not significantly alter the risk of poor clinical outcomes in the treatment of BSIs secondary to Enterobacter, Serratia, or Citrobacter species compared to other antimicrobial agents. |
| Databáze: | OpenAIRE |
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