University of South Carolina School of Medicine, 2 Medical Park, Suite 502, Columbia, SC, 29203, USA.
Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA.
Infection. 2017 Oct;45(5):613-620. doi: 10.1007/s15010-017-1020-5. Epub 2017 May 6.
Optimal antimicrobial treatment duration for Gram-negative bloodstream infection (BSI) remains unclear. This retrospective cohort study examined effectiveness of short (7-10 days) and long (>10 days) courses of antimicrobial therapy for uncomplicated Gram-negative BSI.
Hospitalized adults with uncomplicated Gram-negative BSI at Palmetto Health hospitals in Columbia SC, USA from January 1, 2010 to December 31, 2013 were identified. Multivariate Cox proportional hazards regression with propensity score adjustment was used to examine risk of treatment failure in the two groups.
During the study period, 117 and 294 patients received short and long courses of antimicrobial therapy for uncomplicated Gram-negative BSI, respectively. Overall, the median age was 67 years, 258 (63%) were women, 282 (69%) had urinary source of infection, and 271 (66%) had BSI due to Escherichia coli. The median duration of antimicrobial therapy was 8.5 and 13.3 days in the short and long treatment groups, respectively. After adjustment for the propensity to use a short course of therapy, risk of treatment failure was higher in patients receiving short compared to long courses of antimicrobial agents (HR 2.60, 95% CI: 1.20-5.53, p = 0.02). Other risk factors for treatment failure included liver cirrhosis (HR 5.83, 95% CI: 1.89-15.02, p = 0.004) and immune compromised status (HR 4.30, 95% CI: 1.57-10.80, p = 0.006). Definitive antimicrobial therapy with intravenous or highly bioavailable oral agents was associated with reduced risk of treatment failure (HR 0.33, 95% CI: 0.14-0.73, p = 0.006).
The current results support common clinical practice of 2 weeks of antimicrobial therapy for uncomplicated Gram-negative BSI.
革兰氏阴性菌血流感染（BSI）的最佳抗菌治疗持续时间仍不清楚。本回顾性队列研究调查了简化的革兰氏阴性菌 BSI 短期（7-10 天）和长期（>10 天）抗菌治疗的疗效。
在美国南卡罗来纳州哥伦比亚市 Palmetto Health 医院住院的革兰氏阴性菌 BSI 患者，其时间范围为 2010 年 1 月 1 日至 2013 年 12 月 31 日。使用多变量 Cox 比例风险回归和倾向评分调整来检查两组治疗失败的风险。
在研究期间，117 例和 294 例患者分别接受了简化的革兰氏阴性菌 BSI 短期和长期的抗菌治疗。总体而言，中位年龄为 67 岁，258 例（63%）为女性，282 例（69%）的感染源为尿路感染，271 例（66%）为大肠埃希菌所致的 BSI。短期和长期治疗组抗菌治疗的中位持续时间分别为 8.5 和 13.3 天。在调整了接受短期治疗的倾向后，与长期抗菌药物治疗相比，接受短期治疗的患者治疗失败的风险更高（HR 2.60，95%CI：1.20-5.53，p=0.02）。其他治疗失败的危险因素包括肝硬化（HR 5.83，95%CI：1.89-15.02，p=0.004）和免疫功能低下状态（HR 4.30，95%CI：1.57-10.80，p=0.006）。静脉或高生物利用度口服抗菌药物的确定性抗菌治疗与降低治疗失败风险相关（HR 0.33，95%CI：0.14-0.73，p=0.006）。
目前的结果支持简化的革兰氏阴性菌 BSI 治疗 2 周的临床常规。
