Department of Pharmacy, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
BMC Infect Dis. 2020 Aug 17;20(1):604. doi: 10.1186/s12879-020-05312-z.
Infectious Diseases Society of America (IDSA) guidelines suggest 7-14 days' duration of antibiotic treatment for uncomplicated Gram-negative bacteria (GNB) catheter-related bloodstream infection (CRBSI). The objectives of this study were to review microbial epidemiology, to determine rate and risk factors for relapse, and to compare clinical outcomes in patients receiving long- versus short-duration antibiotic therapy.
A retrospective phase 1 study was conducted between January 2010 and October 2016 to review microbial epidemiology and to determine the incidence of and risk factors for relapse in patients with GNB CRBSI, according to the IDSA guidelines diagnostic criteria. In phase 2 of the study, patients without risk factors for relapse between November 2016 and October 2017 were prospectively recruited to receive antibiotic therapy for 7 days after catheter removal. Matched patients from the retrospective phase 1 study who had received antibiotic therapy for ≥14 days were selected as a phase 2 control group to compare outcomes.
In phase 1, three most common pathogens identified among 174 cases were Pseudomonas aeruginosa (22.0%), Klebsiella pneumoniae (16.7%), and Stenotrophomonas maltophilia (13.4%). Eighty-nine episodes of infection occurred while patients were receiving antibiotic therapy. Of 140 cases, the relapse rate was 6.4%. Catheter retention was the only risk factor strongly associated with relapse (odds ratio = 145.32; 95% confidence interval 12.66-1667.37, P < 0.001). In phase 2, 11 patients with catheter removal were prospectively recruited to receive short-duration therapy. The number of patients with relapse receiving long- or short-duration therapy was 1 (3%) and 0 (0%), respectively (P = 1.000).
For the management of patients with uncomplicated GNB CRBSI, empiric broad-spectrum antibiotic therapy with adequate coverage of P. aeruginosa should be chosen. Catheter removal should be performed to prevent relapse and shortening the duration of treatment could be considered.
Thai Clinical Trial Registry: TCTR20190914001 . Retrospectively registered on 13 September 2019.
美国传染病学会 (IDSA) 指南建议，对于无并发症的革兰氏阴性菌（GNB）导管相关血流感染（CRBSI），抗生素治疗的持续时间应为 7-14 天。本研究的目的是回顾微生物流行病学，确定复发的发生率和危险因素，并比较接受长疗程与短疗程抗生素治疗的患者的临床结局。
一项回顾性的 1 期研究于 2010 年 1 月至 2016 年 10 月进行，以回顾微生物流行病学，并根据 IDSA 指南诊断标准确定 GNB CRBSI 患者复发的发生率和危险因素。在研究的 2 期，2016 年 11 月至 2017 年 10 月期间，无复发危险因素的患者前瞻性入组，在导管拔除后接受 7 天的抗生素治疗。从回顾性 1 期研究中选择接受治疗时间≥14 天的匹配患者作为 2 期对照组，以比较结局。
在 1 期研究中，在 174 例患者中发现三种最常见的病原体分别是铜绿假单胞菌（22.0%）、肺炎克雷伯菌（16.7%）和嗜麦芽窄食单胞菌（13.4%）。在接受抗生素治疗的过程中，有 89 例感染发生。在 140 例患者中，复发率为 6.4%。导管留置是与复发强烈相关的唯一危险因素（比值比=145.32；95%置信区间 12.66-1667.37，P<0.001）。在 2 期，有 11 例患者在导管拔除后前瞻性入组接受短疗程治疗。接受长疗程或短疗程治疗的复发患者分别为 1 例（3%）和 0 例（0%）（P=1.000）。
对于治疗无并发症的 GNB CRBSI 患者，应选择经验性广谱抗生素治疗，充分覆盖铜绿假单胞菌。应进行导管拔除以预防复发，并可考虑缩短治疗时间。
泰国临床试验注册中心：TCTR20190914001。于 2019 年 9 月 13 日回顾性注册。
