Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.
J Antimicrob Chemother. 2018 Nov 1;73(11):3176-3180. doi: 10.1093/jac/dky323.
Carbapenems are widely recommended for the treatment of infections caused by ESBL producers however, non-carbapenem β-lactams such as β-lactam/β-lactamase inhibitor combinations (BLBLIs) deserve consideration for the treatment of ESBL infections. Cefoperazone/sulbactam is one of the most commonly used BLBLIs in China; however, few outcome studies have been reported. In this study, we evaluated and compared the clinical efficacy of cefoperazone/sulbactam with that of a carbapenem in the treatment of bloodstream infections (BSIs) caused by ESBL-producing Enterobacteriaceae.
Patients with monomicrobial ESBL-producing Enterobacteriaceae BSIs empirically treated with cefoperazone/sulbactam or a carbapenem were included. Outcomes of interest were clinical response and 14 day mortality. To make a comparison of the efficacy of cefoperazone/sulbactam and a carbapenem more accurate, propensity score analysis was performed.
No statistically significant differences in success rates or 14 day mortality were found between the cefoperazone/sulbactam (n = 17) and carbapenem (n = 46) groups. In the propensity score analysis with 17 case-control pairs, the success rate in the cefoperazone/sulbactam group (70.6%, 12/17) was lower than that in the carbapenem group (94.1%, 16/17), but the difference was not significant (P = 0.175). Sepsis-related mortality and 14 day mortality rates did not significantly differ either (P = 1.000 for both). In the cefoperazone/sulbactam group, 66.7% (2/3) of the patients with a Pitt bacteraemia score ≥5 died within 14 days, whereas none (0/14) of the patients with a Pitt bacteraemia score <5 died within 14 days (P = 0.022).
This study showed that cefoperazone/sulbactam had a lower success rate and a higher 14 day mortality rate compared with carbapenems, although the differences were not statistically significant because of the small patient numbers. Further evaluation of cefoperazone/sulbactam is needed.
碳青霉烯类药物被广泛推荐用于治疗产 ESBL 细菌引起的感染，然而，β-内酰胺/β-内酰胺酶抑制剂合剂（BLBLIs）等非碳青霉烯类β-内酰胺类药物也值得考虑用于治疗 ESBL 感染。头孢哌酮/舒巴坦是中国最常用的 BLBLIs 之一，但很少有关于其疗效的研究报告。在这项研究中，我们评估并比较了头孢哌酮/舒巴坦与碳青霉烯类药物治疗产 ESBL 肠杆菌科细菌血流感染（BSI）的临床疗效。
纳入经验性使用头孢哌酮/舒巴坦或碳青霉烯类药物治疗的单一致病菌产 ESBL 肠杆菌科细菌 BSI 患者。观察指标为临床疗效和 14 天死亡率。为了更准确地比较头孢哌酮/舒巴坦和碳青霉烯类药物的疗效，进行了倾向评分分析。
头孢哌酮/舒巴坦组（n=17）和碳青霉烯类组（n=46）的治疗成功率和 14 天死亡率无统计学差异。在 17 对病例对照分析中，头孢哌酮/舒巴坦组（70.6%，12/17）的治疗成功率低于碳青霉烯类组（94.1%，16/17），但差异无统计学意义（P=0.175）。两组患者的脓毒症相关死亡率和 14 天死亡率也无统计学差异（均为 P=1.000）。在头孢哌酮/舒巴坦组中，Pitt 菌血症评分≥5 分的患者中，66.7%（2/3）在 14 天内死亡，而 Pitt 菌血症评分<5 分的患者无一例（0/14）在 14 天内死亡（P=0.022）。
本研究表明，与碳青霉烯类药物相比，头孢哌酮/舒巴坦的治疗成功率较低，14 天死亡率较高，尽管由于患者数量较少，差异无统计学意义。需要进一步评估头孢哌酮/舒巴坦的疗效。
