Hogan Michael, Bridgeman Mary Barna, Min Gee Hee, Dixit Deepali, Bridgeman Patrick J, Narayanan Navaneeth
Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA,
Division of Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Infect Drug Resist. 2018 Oct 25;11:1975-1981. doi: 10.2147/IDR.S174570. eCollection 2018.
To evaluate the use of aztreonam as an active empiric therapy against subsequent culture of .
This was a retrospective cohort study conducted among patients who received either aztreonam or an antipseudomonal beta-lactam (BL) as an empiric therapy with subsequent culture with . All patients with at least one positive culture for between January 2014 and August 2016 were included in this analysis. The primary composite outcome was empiric therapy failure, defined as inappropriate empiric therapy, alteration of empiric antibiotic following culture results, or 30-day in-hospital mortality. Secondary outcomes included appropriate empiric therapy, alteration of empiric therapy, 30-day-in-hospital mortality, and post-culture hospital length of stay.
The primary outcome of empiric therapy failure was significantly higher in the aztreonam group than in the BL group (77.8% vs 41.9%; =0.004). The aztreonam group had a lower rate of appropriate empiric therapy compared with the BL group (44.4% vs 66.1%; =0.074) and higher alteration of empiric therapy once susceptibilities were known than when compared with the BL group (61.1%vs 28.2%; =0.005). Although numerically higher, 30-day-in-hospital mortality and median hospital length of stay were not significantly different between the two groups.
Empiric therapy failure occurred more often when initially using aztreonam vs a BL in a patient who subsequently had a infection. Only a third of patients within the aztreonam group had a documented BL allergy, demonstrating an inclination for clinicians to utilize this drug as an empiric therapy when there were more appropriate therapies available.
评估氨曲南作为针对后续培养物的有效经验性治疗药物的使用情况。
这是一项回顾性队列研究，研究对象为接受氨曲南或抗假单胞菌β-内酰胺类（BL）作为经验性治疗并随后进行培养的患者。纳入了2014年1月至2016年8月期间至少有一次培养结果为阳性的所有患者。主要复合结局为经验性治疗失败，定义为经验性治疗不当、根据培养结果改变经验性抗生素或30天院内死亡率。次要结局包括适当的经验性治疗、经验性治疗的改变、30天院内死亡率以及培养后住院时间。
氨曲南组经验性治疗失败的主要结局显著高于BL组（77.8%对41.9%；P=0.004）。与BL组相比，氨曲南组适当经验性治疗的比例较低（44.4%对66.1%；P=0.074），一旦已知药敏情况，氨曲南组经验性治疗的改变率高于BL组（61.1%对28.2%；P=0.005）。尽管在数值上较高，但两组之间的30天院内死亡率和中位住院时间没有显著差异。
在随后发生[具体感染名称未给出]感染的患者中，最初使用氨曲南与使用BL相比，经验性治疗失败更常发生。氨曲南组中只有三分之一的患者有记录的BL过敏，这表明在有更合适治疗方法可用时，临床医生倾向于将这种药物用作经验性治疗。
