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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...

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Autores principales: 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
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
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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.
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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
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