Medicine E, Rabin Medical Center, Beilinson Hospital, Peta-Tikva, Israel.
Infectious Disease Division, Rambam Health Care Campus, Haifa, Israel.
Microb Drug Resist. 2021 Mar;27(3):410-414. doi: 10.1089/mdr.2020.0234. Epub 2020 Aug 17.
Carbapenems are considered treatment of choice for bacteremia caused by potential AmpC-producing bacteria, including spp. We aimed to compare mortality following carbapenem vs. alternative antibiotics for the treatment of spp. bacteremia. We conducted a retrospective study in two centers in Israel. We included hospitalized patients with bacteremia treated with third-generation cephalosporins (3GC), piperacillin/tazobactam, quinolones, or carbapenem monotherapy as the main antibiotic in the first week of treatment, between 2010 and 2017. Cefepime was excluded due to nonavailability during study years. The primary outcome was 30-day all-cause mortality. Univariate and multivariate analyses were conducted, introducing the main antibiotic as an independent variable. Two hundred seventy-seven consecutive patients were included in the analyses. Of these, 73 were treated with 3GC, 39 with piperacillin/tazobactam, 104 with quinolones, and 61 with carbapenems. All-cause 30-day mortality was 16% (45 patients). The type of antibiotics was not significantly associated with mortality on univariate or multivariate analyses. With carbapenems as reference, adjusted odds ratios (ORs) for mortality were 0.708, 95% confidence interval (CI) 0.231-2.176 with 3GC; OR 1.172, 95% CI 0.388-3.537 with piperacillin/tazobactam; and OR 0.586, 95% CI 0.229-1.4 with quinolones. The main antibiotic was not associated with repeated growth of spp. in blood cultures or other clinical specimens. Resistance development was observed with 3GC and piperacillin/tazobactam. Carbapenem treatment was not advantageous to alternative antibiotics, including 3GC, among patients with spp. bacteremia in an observational study.
碳青霉烯类药物被认为是治疗由潜在产 AmpC 细菌引起的菌血症的首选药物，包括 spp。我们旨在比较碳青霉烯类药物与其他抗生素治疗 spp 菌血症的死亡率。
我们在以色列的两个中心进行了一项回顾性研究。我们纳入了在 2010 年至 2017 年间，接受第三代头孢菌素（3GC）、哌拉西林/他唑巴坦、喹诺酮类药物或碳青霉烯类单药治疗作为治疗的主要抗生素，在治疗的第一周内患有 spp 菌血症的住院患者。由于研究期间无法获得头孢吡肟，因此将其排除在外。主要结局是 30 天全因死亡率。进行了单变量和多变量分析，将主要抗生素作为独立变量。
277 例连续患者纳入分析。其中，73 例接受 3GC 治疗，39 例接受哌拉西林/他唑巴坦治疗，104 例接受喹诺酮类药物治疗，61 例接受碳青霉烯类药物治疗。全因 30 天死亡率为 16%（45 例）。单变量和多变量分析均未显示抗生素类型与死亡率显著相关。以碳青霉烯类药物为参照，3GC 的调整后死亡率比值比（OR）为 0.708，95%置信区间（CI）为 0.231-2.176；哌拉西林/他唑巴坦的 OR 为 1.172，95%CI 为 0.388-3.537；喹诺酮类药物的 OR 为 0.586，95%CI 为 0.229-1.4。主要抗生素与血液培养或其他临床标本中 spp. 的重复生长无关。观察到 3GC 和哌拉西林/他唑巴坦的耐药性发展。
在一项观察性研究中，碳青霉烯类药物治疗并未优于其他抗生素，包括 3GC，在治疗 spp.菌血症的患者中。
