Department of Pharmacy, Mayo Clinic Hospital - Rochester, 200 First Street SW, Rochester, MN 55905, USA.
Department of Pharmacy, Ohio State University Wexner Medical Center, Columbus, OH, USA.
J Glob Antimicrob Resist. 2019 Sep;18:243-248. doi: 10.1016/j.jgar.2019.03.013. Epub 2019 Mar 26.
Transitioning patients from intravenous (IV) to oral antibiotic therapy has been shown to be a successful approach for several infections. However, minimal data exist evaluating outcomes following transition from to oral antibiotics for patients with bacteraemia secondary to a urinary tract infection (UTI). This study compared treatment failures between patients treated exclusively with IV antibiotics and those transitioned from IV to oral antibiotics for bacteraemia secondary to UTI.
This single-centre, retrospective cohort study included hospitalised, non-critically ill adult patients treated with culture-susceptible antibiotic therapy for 7-21 days. Patients were divided into two cohorts based on the route of definitive antibiotic administration. Treatment failure was a composite outcome of death and recurrence of the index micro-organism within 21 days following negative blood cultures.
Among the 346 patients enrolled, 82 (23.7%) were in the IV cohort and 264 (76.3%) were in the IV-to-oral cohort. A total of six treatment failures occurred; 2 (2.4%) in the IV cohort and 4 (1.5%) in the oral transition cohort (hazard ratio=0.62, 95% confidence interval 0.11-3.39; P=0.58). All failures were due to recurrence of the index organism. Secondary outcomes demonstrated a significantly higher rate of IV line-associated complications in the IV cohort (P=0.03) and a favourable hospital length of stay in the oral cohort (P<0.001). Patients transitioned from IV to oral antibiotics based on culture-susceptibility data experienced similarly low rates of treatment failure as those who received exclusive IV therapy.
将患者从静脉（IV）抗生素治疗转为口服抗生素治疗已被证明是治疗多种感染的有效方法。然而，对于因尿路感染（UTI）导致菌血症的患者，从静脉转为口服抗生素后，其转归的数据很少。本研究比较了单纯接受静脉抗生素治疗的患者和因菌血症而从静脉转为口服抗生素的患者之间的治疗失败率。
这是一项单中心、回顾性队列研究，纳入了接受培养敏感抗生素治疗 7-21 天的住院、非危重症成年患者。患者根据最终抗生素给药途径分为两组。治疗失败是指血培养阴性后 21 天内死亡和索引微生物再次出现的复合结局。
在纳入的 346 例患者中，82 例（23.7%）在静脉组，264 例（76.3%）在静脉-口服组。共有 6 例治疗失败，静脉组 2 例（2.4%），口服转换组 4 例（1.5%）（风险比=0.62，95%置信区间 0.11-3.39；P=0.58）。所有失败均归因于索引病原体的再次出现。次要结局显示，静脉组静脉导管相关并发症发生率显著更高（P=0.03），而口服组的住院时间更短（P<0.001）。根据药敏数据从静脉转为口服抗生素的患者治疗失败率与单纯接受静脉治疗的患者相似。
