Department of Pharmacy, 368 Doan Hall, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA.
Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Support Care Cancer. 2021 Sep;29(9):5057-5064. doi: 10.1007/s00520-021-06063-6. Epub 2021 Feb 16.
Bloodstream infections (BSI) are significant causes of morbidity and mortality in cancer patients. These patients often receive 10 to 14 days of intravenous (IV) antibiotics. The objective of this study was to compare the outcomes of cancer patients transitioned from IV to oral (PO) therapy compared to continuation of IV treatment.
This was a single-center, retrospective cohort study of hospitalized adult cancer patients with gram-negative bacteremia. Patients transitioned to a PO fluoroquinolone (FQ) within 5 days were allocated to the IV-to-PO group, while the remaining patients comprised the IV group. The primary outcome was the composite of treatment failure, defined as infection-related readmission, infection recurrence, or inpatient mortality. A multivariable logistic regression model was constructed to account for confounding variables. Secondary outcomes assessed included infection-related length of stay (LOS), hospital LOS, and adverse events, such as Clostridioides difficile infection and catheter-related complications.
The IV-to-PO group included 78 patients, while the remaining 133 patients were allocated to the IV group. Differences at baseline included more hematologic malignancy, neutropenia, ICU admissions, and higher Pitt bacteremia scores in the IV group. The rate of treatment failure was significantly higher in the IV group (24% vs 9%; p < 0.01), which persisted in the logistic regression (aOR 3.5, 95% CI 1.3-9.1). The IV-to-PO group had decreased infection-related and hospital length of stay, as well as fewer catheter-related complications.
The use of PO FQ may be considered for the definitive treatment of uncomplicated Enterobacterales BSI in cancer patients.
血流感染（BSI）是癌症患者发病率和死亡率的重要原因。这些患者通常接受 10 至 14 天的静脉（IV）抗生素治疗。本研究的目的是比较从 IV 转为口服（PO）治疗的癌症患者与继续 IV 治疗的患者的结局。
这是一项单中心、回顾性队列研究，纳入了患有革兰氏阴性菌血症的住院成年癌症患者。在 5 天内转为口服氟喹诺酮（FQ）的患者被分配到 IV 至 PO 组，而其余患者构成 IV 组。主要结局是治疗失败的复合结局，定义为与感染相关的再入院、感染复发或住院内死亡。构建多变量逻辑回归模型来校正混杂变量。评估的次要结局包括感染相关的住院时间（LOS）、医院 LOS 和不良事件，如艰难梭菌感染和导管相关并发症。
IV 至 PO 组包括 78 例患者，其余 133 例患者被分配到 IV 组。基线时的差异包括 IV 组更多的血液恶性肿瘤、中性粒细胞减少症、重症监护病房（ICU）入院和更高的 Pitt 菌血症评分。IV 组的治疗失败率显著更高（24%比 9%；p<0.01），这在逻辑回归中仍然存在（aOR 3.5，95%CI 1.3-9.1）。IV 至 PO 组的感染相关和医院 LOS 缩短，且导管相关并发症较少。
对于癌症患者中不复杂的肠杆菌科血流感染，口服 FQ 可能可被考虑作为确定性治疗方法。
