Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain.
Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
Int J Antimicrob Agents. 2019 Aug;54(2):189-196. doi: 10.1016/j.ijantimicag.2019.05.004. Epub 2019 May 7.
Carbapenems are considered the treatment of choice for extended-spectrum β-lactamase (ESBL)- or AmpC β-lactamase-producing Enterobacteriaceae bacteraemia. Data on the effectiveness of non-intravenous carbapenem-sparing antibiotic options are limited. This study compared the 30-day mortality and clinical failure associated with the use of carbapenems versus alternative non-intravenous antibiotics for the definitive treatment of ESBL/AmpC-positive Enterobacteriaceae bacteraemia. This 12-year retrospective study (2004-2015) included all patients with bacteraemia due to ESBL/AmpC-producing Enterobacteriaceae at a Spanish hospital. Given the lack of randomisation of initial therapies, a propensity score for receiving carbapenems was calculated. There were 1115 patients with a first episode of bacteraemia due to Escherichia coli or Klebsiella pneumoniae, of which 123 (11.0%) were ESBL/AmpC-positive. There were 101 eligible patients: 59 in the carbapenem group and 42 in the alternative treatment group (trimethoprim/sulfamethoxazole 59.5%, quinolones 21.4%). The most frequent sources of infection were urinary (63%) and biliary (15%). Compared with the carbapenem group, patients treated with an alternative regimen had a shorter hospital stay [median (IQR) 7 (5-10) days vs. 12 (9-18) days; P < 0.001]. Use of an alternative non-intravenous therapy did not increase mortality (OR = 0.27, 95% CI 0.05-1.61; P = 0.15). After controlling for confounding factors with the propensity score, the adjusted OR of carbapenem treatment was 4.95 (95% CI 0.94-26.01; P = 0.059). Alternative non-intravenous carbapenem-sparing antibiotics could have a role in the definitive treatment of ESBL/AmpC-positive Enterobacteriaceae bacteraemia, allowing a reduction in carbapenem use. Use of trimethoprim/sulfamethoxazole in this series showed favourable results.
碳青霉烯类药物被认为是治疗产超广谱β-内酰胺酶（ESBL）或AmpCβ-内酰胺酶的肠杆菌科细菌血症的首选药物。关于非静脉用碳青霉烯类药物节约型抗生素选择的有效性的数据有限。本研究比较了碳青霉烯类药物与其他非静脉用抗生素在治疗产 ESBL/AmpC 阳性肠杆菌科细菌血症的确定性治疗中的 30 天死亡率和临床失败率。这是一项回顾性研究（2004-2015 年），包括在一家西班牙医院发生的产 ESBL/AmpC 肠杆菌科细菌血症的所有患者。鉴于初始治疗的随机分组缺乏，计算了接受碳青霉烯类药物的倾向评分。共有 1115 例因产 ESBL/AmpC 的大肠埃希菌或肺炎克雷伯菌引起的首次菌血症患者，其中 123 例（11.0%）为 ESBL/AmpC 阳性。共有 101 例符合条件的患者：碳青霉烯组 59 例，替代治疗组 42 例（复方磺胺甲噁唑 59.5%，喹诺酮类 21.4%）。最常见的感染源是尿（63%）和胆道（15%）。与碳青霉烯组相比，接受替代方案治疗的患者住院时间更短[中位数（IQR）7（5-10）天比 12（9-18）天；P＜0.001]。使用替代非静脉内治疗不会增加死亡率（比值比[OR]=0.27，95%置信区间[CI]0.05-1.61；P=0.15）。在校正倾向评分后的混杂因素后，碳青霉烯类药物治疗的调整后 OR 为 4.95（95%CI 0.94-26.01；P=0.059）。替代非静脉用碳青霉烯类药物节约型抗生素在治疗产 ESBL/AmpC 阳性肠杆菌科细菌血症的确定性治疗中可能发挥作用，可减少碳青霉烯类药物的使用。本系列中使用复方磺胺甲噁唑显示出良好的结果。
