Cargando…
Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species
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 oth...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277875/ https://www.ncbi.nlm.nih.gov/pubmed/32423104 http://dx.doi.org/10.3390/antibiotics9050254 |
_version_ | 1783543220552073216 |
---|---|
author | Derrick, Caroline Bookstaver, P. Brandon Lu, Zhiqiang K. Bland, Christopher M. King, S. Travis Stover, Kayla R. Rumley, Kathey MacVane, Shawn H. Swindler, Jenna Kincaid, Scott Branan, Trisha Cluck, David Britt, Benjamin Pillinger, Kelly E. Jones, Bruce M. Fleming, Virginia DiMondi, V. Paul Estrada, Sandy Crane, Brad Odle, Brian Al-Hasan, Majdi N. Justo, Julie Ann |
author_facet | Derrick, Caroline Bookstaver, P. Brandon Lu, Zhiqiang K. Bland, Christopher M. King, S. Travis Stover, Kayla R. Rumley, Kathey MacVane, Shawn H. Swindler, Jenna Kincaid, Scott Branan, Trisha Cluck, David Britt, Benjamin Pillinger, Kelly E. Jones, Bruce M. Fleming, Virginia DiMondi, V. Paul Estrada, Sandy Crane, Brad Odle, Brian Al-Hasan, Majdi N. Justo, Julie Ann |
author_sort | Derrick, Caroline |
collection | PubMed |
description | 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 0.51–1.72) 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. |
format | Online Article Text |
id | pubmed-7277875 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-72778752020-06-12 Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species Derrick, Caroline Bookstaver, P. Brandon Lu, Zhiqiang K. Bland, Christopher M. King, S. Travis Stover, Kayla R. Rumley, Kathey MacVane, Shawn H. Swindler, Jenna Kincaid, Scott Branan, Trisha Cluck, David Britt, Benjamin Pillinger, Kelly E. Jones, Bruce M. Fleming, Virginia DiMondi, V. Paul Estrada, Sandy Crane, Brad Odle, Brian Al-Hasan, Majdi N. Justo, Julie Ann Antibiotics (Basel) Article 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 0.51–1.72) 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. MDPI 2020-05-14 /pmc/articles/PMC7277875/ /pubmed/32423104 http://dx.doi.org/10.3390/antibiotics9050254 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Derrick, Caroline Bookstaver, P. Brandon Lu, Zhiqiang K. Bland, Christopher M. King, S. Travis Stover, Kayla R. Rumley, Kathey MacVane, Shawn H. Swindler, Jenna Kincaid, Scott Branan, Trisha Cluck, David Britt, Benjamin Pillinger, Kelly E. Jones, Bruce M. Fleming, Virginia DiMondi, V. Paul Estrada, Sandy Crane, Brad Odle, Brian Al-Hasan, Majdi N. Justo, Julie Ann Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species |
title | Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species |
title_full | Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species |
title_fullStr | Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species |
title_full_unstemmed | Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species |
title_short | Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species |
title_sort | multicenter, observational cohort study evaluating third-generation cephalosporin therapy for bloodstream infections secondary to enterobacter, serratia, and citrobacter species |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277875/ https://www.ncbi.nlm.nih.gov/pubmed/32423104 http://dx.doi.org/10.3390/antibiotics9050254 |
work_keys_str_mv | AT derrickcaroline multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT bookstaverpbrandon multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT luzhiqiangk multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT blandchristopherm multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT kingstravis multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT stoverkaylar multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT rumleykathey multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT macvaneshawnh multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT swindlerjenna multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT kincaidscott multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT branantrisha multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT cluckdavid multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT brittbenjamin multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT pillingerkellye multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT jonesbrucem multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT flemingvirginia multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT dimondivpaul multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT estradasandy multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT cranebrad multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT odlebrian multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT alhasanmajdin multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies AT justojulieann multicenterobservationalcohortstudyevaluatingthirdgenerationcephalosporintherapyforbloodstreaminfectionssecondarytoenterobacterserratiaandcitrobacterspecies |