Wang Ruibin, Cosgrove Sara E, Tschudin-Sutter Sarah, Han Jennifer H, Turnbull Alison E, Hsu Alice J, Avdic Edina, Carroll Karen C, Tamma Pranita D
Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health.
Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Open Forum Infect Dis. 2016 Jun 20;3(3):ofw132. doi: 10.1093/ofid/ofw132. eCollection 2016 Sep.
The role of cefepime for extended-spectrum β-lactamase (ESBL) bacteremia is unclear if susceptible in vitro. In a propensity score-matched study of patients with ESBL bacteremia, risk of death was 2.87 times higher for patients receiving cefepime compared with carbapenems (95% confidence interval [CI], .88-9.41). We compared 14-day mortality of patients with ESBL bacteremia receiving empiric cefepime versus empiric carbapenem therapy in a propensity score-matched cohort. There was a trend towards increased mortality in the cefepime group (hazard ratio, 2.87; 95% CI, .88-9.41), which enhances the existing literature suggesting that cefepime may be suboptimal for invasive ESBL infections.
对于产超广谱β-内酰胺酶（ESBL）菌血症患者，如果头孢吡肟在体外敏感，其作用尚不清楚。在一项针对ESBL菌血症患者的倾向评分匹配研究中，接受头孢吡肟治疗的患者死亡风险比接受碳青霉烯类药物治疗的患者高2.87倍（95%置信区间[CI]，0.88 - 9.41）。我们在一个倾向评分匹配队列中比较了接受经验性头孢吡肟治疗与经验性碳青霉烯类药物治疗的ESBL菌血症患者的14天死亡率。头孢吡肟组有死亡率增加的趋势（风险比，2.87；95%CI，0.88 - 9.41），这进一步支持了现有文献表明头孢吡肟对于侵袭性ESBL感染可能并非最佳选择的观点。
