Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA.
Immun Inflamm Dis. 2021 Dec;9(4):1786-1794. doi: 10.1002/iid3.486. Epub 2021 Jul 21.
The increasing proportion of outpatient allogeneic hematopoietic cell transplants (HCTs) coupled with increased access of once-daily broad-spectrum antibiotics and evidence that outpatient antibiotic treatment may be safer and less costly than inpatient treatment, suggest that allogeneic HCT recipients with Gram-negative rod bacteremia (GNRBs) are increasingly being treated in ambulatory care settings.
Using data from the first GNRB event that occurred within the first 100 days posttransplantation among allogeneic HCT recipients transplanted at a single center between 2007 and 2016, we estimated the temporal trends in GNRB incidence and treatment management of GNRBs and identified if patient or infection characteristics impacted observed trends.
A total of 11% (238/2165) of the observed allogeneic HCT recipients experienced ≥1 GNRB with available resistance data and contributed antibiotic treatment time. Patients, on average, received 55.1% of their antibiotic treatment in an outpatient setting and we observed a significant decline in the proportion of treatment time spent outpatient (crude: -3.3% [95% confidence interval: -5.0, -1.6%]). We observed similar declines in the proportion of treatment time spent outpatient among patients with similar GNRB and pretransplant complexity factors but not among patients with similar posttransplant complications (p value: .165).
These results suggest that, despite increased availability of outpatient suitable treatment options, allogeneic HCT recipients with GNRBs received less treatment in outpatient settings. However, among patients with similar posttransplant complications, the lack of significant decline suggests that treatment location decisions remained consistent for patients with similar posttransplant complications. These findings suggest the need for additional interventions targeting outpatient antibiotic treatment among allogeneic HCT recipients with GNRBs.
随着门诊异基因造血细胞移植（HCT）比例的增加，以及每日一次广谱抗生素的可及性增加，并且有证据表明门诊抗生素治疗可能比住院治疗更安全且成本更低，因此，革兰氏阴性杆菌菌血症（GNRB）的异基因 HCT 受者越来越多地在门诊环境中接受治疗。
利用 2007 年至 2016 年间单中心移植的所有异基因 HCT 受者中，在前移植 100 天内首次发生的第一个 GNRB 事件的数据，我们估计了 GNRB 的发生率和 GNRB 的治疗管理的时间趋势，并确定了患者或感染特征是否影响了观察到的趋势。
共有 11%（238/2165）的观察到的异基因 HCT 受者经历了≥1 次 GNRB，且具有可用的耐药数据和抗生素治疗时间。患者平均有 55.1%的抗生素治疗在门诊进行，我们观察到门诊治疗时间比例显著下降（粗率：-3.3%[95%置信区间：-5.0，-1.6%]）。我们在具有相似 GNRB 和移植前复杂性因素的患者中观察到类似的门诊治疗时间比例下降，但在具有相似移植后并发症的患者中没有观察到（p 值：.165）。
尽管门诊治疗的选择增加，但患有 GNRB 的异基因 HCT 受者的门诊治疗比例仍有所下降。然而，在具有相似移植后并发症的患者中，由于治疗地点的决策对具有相似移植后并发症的患者保持一致，因此未出现显著下降。这些结果表明，需要针对患有 GNRB 的异基因 HCT 受者的门诊抗生素治疗进行额外的干预。
