Lo Ching-Lung, Lee Ching-Chi, Li Chia-Wen, Li Ming-Chi, Hsueh Po-Ren, Lee Nan-Yao, Ko Wen-Chien
Department of Internal Medicine, National Cheng Kung University Hospital, Tainin, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, Tainin, Taiwan; Center of Infection Control, National Cheng Kung University Hospital, Tainin, Taiwan.
J Microbiol Immunol Infect. 2017 Jun;50(3):355-361. doi: 10.1016/j.jmii.2015.08.012. Epub 2015 Sep 9.
BACKGROUND/PURPOSE: For extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae infections, carbapenems are recommended as first line therapy, and clinical data on the therapeutic efficacy of fluoroquinolones (FQs) is limited. This study compares the efficacy of FQs and carbapenems for bloodstream infections caused by ESBL-producing Escherichia coli or Klebsiella pneumoniae.
Between 2008 and 2010, adults with ESBL-producing E. coli or K. pneumoniae bacteremia at two medical centers were reviewed. Adults receiving definitive FQ or carbapenem therapy were compared in a propensity score-matched analysis, and 30-day mortality was the primary endpoint.
A total of 299 patients were eligible. Patients receiving a FQ (n = 24), either ciprofloxacin or levofloxacin, had a lower 30-day mortality rate than those with carbapenem therapy (8.3%, 2/24 vs. 23.3%, 64/275; p = 0.12). Multivariate regression analysis revealed that a critical illness [Pitt bacteremia score ≥ 4 points; odds ratio (OR), 7.09; p < 0.001], rapidly fatal underlying disease (OR, 5.73; p < 0.001), and hospital-associated infection (OR, 2.57; p = 0.01) were independently associated with 30-day mortality. By contrast, FQ definitive therapy was a protective factor compared with carbapenems (OR, 0.18; p = 0.04). There were 72 matched cases with carbapenem therapy in a propensity score-matched analysis, and a difference in the 30-day mortality rate of two groups was noted (8.3% vs. 29.2%; p = 0.05).
For ESBL-producing E. coli or K. pneumoniae bacteremia, ciprofloxacin or levofloxacin, if active in vitro, can be considered as a carbapenem-sparing alternative.
背景/目的：对于产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌感染，推荐碳青霉烯类作为一线治疗药物，而关于氟喹诺酮类（FQs）治疗效果的临床数据有限。本研究比较了FQs和碳青霉烯类对产ESBL的大肠埃希菌或肺炎克雷伯菌所致血流感染的疗效。
回顾2008年至2010年期间两个医疗中心患有产ESBL的大肠埃希菌或肺炎克雷伯菌菌血症的成人患者。在倾向评分匹配分析中比较接受确定性FQ或碳青霉烯类治疗的成人患者，30天死亡率为主要终点。
共有299例患者符合条件。接受FQ（n = 24）治疗的患者，即环丙沙星或左氧氟沙星，其30天死亡率低于接受碳青霉烯类治疗的患者（8.3%，2/24 vs. 23.3%，64/275；p = 0.12）。多因素回归分析显示，危重病[皮特菌血症评分≥4分；比值比（OR），7.09；p < 0.001]、快速致命的基础疾病（OR，5.73；p < 0.001）和医院相关性感染（OR，2.57；p = 0.01）与30天死亡率独立相关。相比之下，与碳青霉烯类相比，FQ确定性治疗是一个保护因素（OR，0.18；p = 0.04）。在倾向评分匹配分析中有72例接受碳青霉烯类治疗的匹配病例，两组30天死亡率存在差异（8.3% vs. 29.2%；p = 0.05）。
对于产ESBL的大肠埃希菌或肺炎克雷伯菌菌血症，如果环丙沙星或左氧氟沙星在体外有活性，可考虑作为碳青霉烯类的替代药物。
