Dong Yuzhu, Li Ying, Zhang Ying, Sun Dan, Du Qian, Zhang Tao, Teng Mengmeng, Han Ruiying, Wang Yan, Zhu Li, Lei Jin'e, Dong Yalin, Wang Taotao
Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, People's Republic of China.
Department of Pharmacy, Xi'an NO.3 Hospital, Xi'an 710082, People's Republic of China.
Infect Drug Resist. 2020 May 7;13:1327-1338. doi: 10.2147/IDR.S241648. eCollection 2020.
Gram-negative bacteria bloodstream infection (GNB-BSI) results in considerable mortality and hospitality costs in cirrhotic patients. β-lactam/β-lactamase inhibitor combinations (BLBLIs) and carbapenems (CARs) are widely recommended for treating GNB-BSI in cirrhotic patients, while the efficacy and cost-effectiveness of two strategies have never been evaluated. Therefore, we conducted a retrospective cohort study to evaluate the efficacy and the cost-effectiveness of BLBLIs and CARs.
Cirrhotic patients with GNB-BSI treated by BLBLIs or CARs were included. A propensity score-matching analysis was performed to compare the efficacy between BLBLIs and CARs. A decision tree was used to estimate the clinical outcomes and direct costs of treating BSI using two strategies from the patients' perspective.
No statistically significant difference was found between the BLBLIs (n = 41) group and the CARs (n = 43) group regarding the time to defervescence (2.4 ± 0.2 vs 2.5 ± 0.3, = 0.94). Thirty-seven patients from each group were matched in propensity-score-matched cohort, and there was no significant difference between two groups in terms of the time to defervescence (2.4 ± 0.3 vs 2.4 ± 0.3, = 0.75) and success rate (86.5% vs 78.4%; OR = 0.57; = 0.36). Based on the drug and hospital costs in China, cefoperazone/sulbactam was cost-effective in the present analysis under the willingness-to-pay threshold (¥64,644).
The efficacy of BLBLIs is similar to CARs. Cefoperazone/sulbactam could be a cost-effective therapy in cirrhotic patients with GNB-BSI. Carbapenems-sparing regimens should be encouraged in regions with a low prevalence of MDR bacteria.
革兰氏阴性菌血流感染（GNB - BSI）在肝硬化患者中导致相当高的死亡率和住院费用。β-内酰胺/β-内酰胺酶抑制剂联合制剂（BLBLIs）和碳青霉烯类药物（CARs）被广泛推荐用于治疗肝硬化患者的GNB - BSI，而这两种策略的疗效和成本效益从未得到评估。因此，我们进行了一项回顾性队列研究，以评估BLBLIs和CARs的疗效及成本效益。
纳入接受BLBLIs或CARs治疗的GNB - BSI肝硬化患者。进行倾向评分匹配分析以比较BLBLIs和CARs之间的疗效。使用决策树从患者角度估计两种策略治疗BSI的临床结局和直接成本。
BLBLIs组（n = 41）和CARs组（n = 43）在退热时间方面无统计学显著差异（2.4 ± 0.2对2.5 ± 0.3，P = 0.94）。在倾向评分匹配队列中，每组37例患者匹配，两组在退热时间（2.4 ± 0.3对2.4 ± 0.3，P = 0.75）和成功率（86.5%对78.4%；OR = 0.57；P = 0.36）方面无显著差异。基于中国的药物和医院成本，在支付意愿阈值（64,644元）下，头孢哌酮/舒巴坦在本分析中具有成本效益。
BLBLIs的疗效与CARs相似。头孢哌酮/舒巴坦可能是治疗GNB - BSI肝硬化患者的一种具有成本效益的疗法。在耐多药细菌低流行地区应鼓励采用碳青霉烯类药物节省方案。
