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Effectiveness of oral antibiotics for definitive therapy of Gram-negative bloodstream infections.口服抗生素治疗革兰氏阴性菌血流感染的疗效。
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Antibiotic de-escalation in bacteremic urinary tract infections: potential opportunities and effect on outcome.菌血症性尿路感染中的抗生素降阶梯治疗：潜在机遇及对结局的影响
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A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis.一项双盲、随机对照研究，比较每日一次服用750毫克左氧氟沙星共五天与每日两次服用400/500毫克环丙沙星共十天用于治疗复杂性尿路感染和急性肾盂肾炎的疗效。
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Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.美国感染病学会/美国胸科学会关于成人社区获得性肺炎管理的共识指南。
Clin Infect Dis. 2007 Mar 1;44 Suppl 2(Suppl 2):S27-72. doi: 10.1086/511159.
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Oral vs intravenous ciprofloxacin in the initial empirical management of severe pyelonephritis or complicated urinary tract infections: a prospective randomized clinical trial.口服与静脉注射环丙沙星用于重症肾盂肾炎或复杂性尿路感染的初始经验性治疗：一项前瞻性随机临床试验
Arch Intern Med. 1999 Jan 11;159(1):53-8. doi: 10.1001/archinte.159.1.53.
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Sequential parenteral and oral ciprofloxacin regimen versus parenteral therapy for bacteremia: a pharmacoeconomic analysis.环丙沙星序贯肠外与口服给药方案与肠外给药治疗菌血症的药物经济学分析
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单纯静脉用或静脉转为口服抗菌药物治疗肠杆菌科相关菌血症性尿路感染。

Intravenous-only or Intravenous Transitioned to Oral Antimicrobials for Enterobacteriaceae-Associated Bacteremic Urinary Tract Infection.

机构信息

Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina.

Department of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina.

出版信息

Pharmacotherapy. 2017 Nov;37(11):1479-1483. doi: 10.1002/phar.2024. Epub 2017 Oct 23.

DOI:10.1002/phar.2024
PMID:28869655
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5681413/
Abstract

OBJECTIVES

To characterize antibiotic regimens utilized for bacteremic Enterobacteriaceae urinary tract infections and assess treatment failure associated with intravenous-only compared to intravenous transitioned to oral antibiotic treatment.

DESIGN

Retrospective cohort.

SETTINGS

Tertiary care academic medical center.

PATIENTS

241 adult patients hospitalized between July 1, 2010, and June 30, 2015, with positive blood and urine cultures with the same Enterobacteriaceae pathogen.

MAIN RESULTS

Hospital days on antibiotics as well as length of stay were less in the group treated with any oral antibiotics (intravenous/oral, median 5 [IQR 3-7] days vs intravenous-only antibiotics 6 [4-10] days, p<0.001; length of stay for intravenous/oral 4.6 [3.1-7.8] days vs intravenous-only 7.1 [4.0-17.5] days, p<0.001). No statistically significant difference was found in the composite outcome of treatment failure in patients who received intravenous-only antibiotics versus intravenous/oral antibiotics for the treatment of bacteremic urinary tract infections (intravenous-only 3.8% [95% CI: 1.0-9.4%] failure; intravenous/oral 8.2% [95% CI: 4.1-14.1%] failure; p=0.19).

CONCLUSIONS

Intravenous transitioned to oral treatment (intravenous/oral) was associated with a shorter length of stay and fewer hospital antibiotic days compared with intravenous-only therapy. Transitioning from intravenous to oral antibiotic therapy is a viable treatment option to consider for patients with bacteremic Enterobacteriaceae urinary tract infection.

摘要

目的

描述用于血流感染肠杆菌科尿路感染的抗生素方案，并评估与仅静脉用抗生素治疗相比，静脉转为口服抗生素治疗相关的治疗失败。

设计

回顾性队列研究。

设置

三级保健学术医疗中心。

患者

2010 年 7 月 1 日至 2015 年 6 月 30 日期间住院的 241 例成人患者，其血液和尿液培养均为同一肠杆菌科病原体阳性。

主要结果

接受任何口服抗生素治疗的患者的抗生素治疗天数和住院时间均更短（静脉/口服治疗组的中位数为 5 [IQR 3-7] 天，而仅静脉用抗生素组为 6 [4-10] 天，p<0.001；静脉/口服治疗组的住院时间为 4.6 [3.1-7.8] 天，而仅静脉用抗生素组为 7.1 [4.0-17.5] 天，p<0.001）。接受仅静脉用抗生素与静脉/口服抗生素治疗血流感染性尿路感染的患者中，治疗失败的复合结局无统计学差异（仅静脉用抗生素组为 3.8% [95%CI：1.0-9.4%] 失败；静脉/口服治疗组为 8.2% [95%CI：4.1-14.1%] 失败；p=0.19）。

结论

与仅静脉用抗生素治疗相比，静脉转为口服治疗（静脉/口服）与较短的住院时间和较少的医院抗生素天数相关。对于血流感染性肠杆菌科尿路感染患者，从静脉用抗生素转为口服抗生素治疗是一种可行的治疗选择。