含氨基糖苷类抗生素的初始经验性抗革兰氏阴性菌治疗在血液系统中性粒细胞减少症患者血流感染中的影响：一项倾向性匹配队列研究（AMINOLACTAM 研究）。
Impact of the Inclusion of an Aminoglycoside to the Initial Empirical Antibiotic Therapy for Gram-Negative Bloodstream Infections in Hematological Neutropenic Patients: a Propensity-Matched Cohort Study (AMINOLACTAM Study).
机构信息
Infectious Disease Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
Infections of the Respiratory Tract and in Immunocompromised Patients Research Group, Infectious Diseases and Transplantation Program, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
出版信息
Antimicrob Agents Chemother. 2021 Jul 16;65(8):e0004521. doi: 10.1128/AAC.00045-21.
To test the hypothesis that the addition of an aminoglycoside to a β-lactam antibiotic could provide better outcomes than β-lactam monotherapy for the initial empirical treatment of hematological neutropenic patients with subsequently documented Gram-negative bacillus (GNB) bloodstream infection (BSI), a multinational, retrospective, cohort study of GNB BSI episodes in hematological neutropenic patients in six centers (2010 to 2017) was conducted. Combination therapy (β-lactam plus aminoglycoside) was compared to β-lactam monotherapy. The primary endpoint was the case fatality rate, assessed at 7 and 30 days from BSI onset. Secondary endpoints were nephrotoxicity and persistent BSI. Propensity score (PS) matching was performed. Among 542 GNB BSI episodes, 304 (56%) were initially treated with combination therapy, with cefepime plus amikacin being most common (158/304 [52%]). Overall, Escherichia coli (273/304 [50.4%]) was the main etiological agent, followed by Pseudomonas aeruginosa, which predominated in the combination group (76/304 [25%] versus 28/238 [11.8%]; < 0.001). Multidrug resistance rates were similar between groups (83/294 [28.2%] versus 63/233 [27%]; = 0.95). In the multivariate analysis, combination therapy was associated with a lower 7-day case fatality rate (odds ratio [OR], 0.37; 95% CI, 0.14 to 0.91; = 0.035) with a tendency toward lower mortality at 30 days (OR, 0.56; 95% CI, 0.29 to 1.08; = 0.084). After PS matching, these differences remained for the 7-day case fatality rate (OR, 0.33; 95% CI, 0.13 to 0.82; = 0.017). In addition, aminoglycoside use was not significantly associated with renal function impairment (OR, 1.12; 95% CI, 0.26 to 4.87; = 0.9). The addition of an aminoglycoside to the initial empirical therapy regimen for febrile neutropenic hematological patients should be considered.
为了检验以下假设，即与β-内酰胺单药治疗相比，在随后确诊为革兰氏阴性菌（GNB）血流感染（BSI）的血液中性粒细胞减少症患者的初始经验性治疗中添加氨基糖苷类药物可提供更好的结果，对 6 个中心（2010 年至 2017 年）的 542 例 GNB BSI 患者进行了一项国际性的回顾性队列研究。联合治疗（β-内酰胺加氨基糖苷类）与β-内酰胺单药治疗进行了比较。主要终点是从 BSI 发病开始的第 7 天和第 30 天的病死率。次要终点是肾毒性和持续性 BSI。进行了倾向评分（PS）匹配。在 542 例 GNB BSI 中，304 例（56%）最初接受联合治疗，其中头孢吡肟加阿米卡星最常见（158/304 [52%]）。总体而言，大肠埃希菌（273/304 [50.4%]）是主要的病因，其次是铜绿假单胞菌，在联合组中占优势（76/304 [25%]与 28/238 [11.8%]； < 0.001）。两组的药物耐药率相似（294 例中的 83/83 [28.2%]与 233 例中的 63/63 [27%]； = 0.95）。在多变量分析中，与第 7 天的病死率降低相关（优势比 [OR]，0.37；95%CI，0.14 至 0.91； = 0.035），第 30 天的死亡率也有下降趋势（OR，0.56；95%CI，0.29 至 1.08； = 0.084）。在进行 PS 匹配后，第 7 天的病死率仍存在差异（OR，0.33；95%CI，0.13 至 0.82； = 0.017）。此外，氨基糖苷类药物的使用与肾功能损害无关（OR，1.12；95%CI，0.26 至 4.87； = 0.9）。对于发热性中性粒细胞减少症的血液学患者，应考虑在初始经验性治疗方案中添加氨基糖苷类药物。
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