Role of Early De-escalation of Antimicrobial Therapy on Risk of Clostridioides difficile Infection Following Enterobacteriaceae Bloodstream Infections
| Autor: | Hana Rac, Krutika N Mediwala, Megan Seddon, Majdi N. Al-Hasan, Julie Ann Justo, P. Brandon Bookstaver, Sangita Dash, Joseph Kohn, Emily Haggard |
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| Rok vydání: | 2018 |
| Předmět: |
Male
0301 basic medicine Microbiology (medical) medicine.medical_specialty Time Factors medicine.drug_class South Carolina 030106 microbiology Antibiotics Bacteremia beta-Lactams Antimicrobial Stewardship 03 medical and health sciences 0302 clinical medicine Enterobacteriaceae Risk Factors Internal medicine Humans Medicine 030212 general & internal medicine Risk factor Aged Retrospective Studies Clostridioides difficile business.industry Incidence Incidence (epidemiology) Hazard ratio Enterobacteriaceae Infections Retrospective cohort study Middle Aged medicine.disease Confidence interval Anti-Bacterial Agents Infectious Diseases Clostridium Infections Female business De-escalation |
| Zdroj: | Clinical Infectious Diseases. 69:414-420 |
| ISSN: | 1537-6591 1058-4838 |
| Popis: | Background There is a paucity of data on the effect of early de-escalation of antimicrobial therapy on rates of Clostridioides difficile infection (CDI). This retrospective cohort study evaluated impact of de-escalation from antipseudomonal β-lactam (APBL) therapy within 48 hours of Enterobacteriaceae bloodstream infections (BSIs) on 90-day risk of CDI. Methods Adult patients hospitalized for >48 hours for treatment of Enterobacteriaceae BSI at Palmetto Health hospitals in Columbia, South Carolina, from 1 January 2011 through 30 June 2015 were identified. Multivariable Cox proportional hazards regression was used to examine time to CDI in patients who received >48 hours or ≤48 hours of APBL for empirical therapy of Enterobacteriaceae BSI after adjustment for the propensity to receive >48 hours of APBL. Results Among 808 patients with Enterobacteriaceae BSI, 414 and 394 received >48 and ≤48 hours of APBL, respectively. Incidence of CDI was higher in patients who received >48 hours than those who received ≤48 hours of APBL (7.0% vs 1.8%; log-rank P = .002). After adjustment for propensity to receive >48 hours of APBL and other variables in the multivariable model, receipt of >48 hours of APBL (hazard ratio [HR], 3.56 [95% confidence interval {CI}, 1.48–9.92]; P = .004) and end-stage renal disease (HR, 4.27 [95% CI, 1.89–9.11]; P = .001) were independently associated with higher risk of CDI. Conclusions The empirical use of APBL for >48 hours was an independent risk factor for CDI. Early de-escalation of APBL using clinical risk assessment tools or rapid diagnostic testing may reduce the incidence of CDI in hospitalized adults with Enterobacteriaceae BSIs. |
| Databáze: | OpenAIRE |
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