Aleissa Muneerah M, Gonzalez-Bocco Isabel H, Zekery-Saad Sara, Kubiak David W, Zhang Eric M, Signorelli Jessie, Hammond Sarah P, Mohareb Amir M, Luskin Marlise R, Manne-Goehler Jennifer, Marty Francisco M
Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Open Forum Infect Dis. 2022 Jun 20;9(8):ofac306. doi: 10.1093/ofid/ofac306. eCollection 2022 Aug.
Methicillin-susceptible (MSSA) is a common cause of bloodstream infection (BSI) in patients with febrile neutropenia, but treatment practices vary, and guidelines are not clear on the optimal regimen.
We conducted a multicenter retrospective cohort study of MSSA BSI in febrile neutropenia. We divided patients into 3 treatment groups: (1) broad-spectrum beta-lactams (ie, piperacillin-tazobactam, cefepime, meropenem); (2) narrow-spectrum beta-lactams (ie, cefazolin, oxacillin, nafcillin); and (3) combination beta-lactams (ie, both narrow- and broad-spectrum). We used multivariable logistic regression to compare 60-day mortality and bacteremia recurrence while adjusting for potential confounders.
We identified 889 patients with MSSA BSI, 128 of whom had neutropenia at the time of the index culture: median age 56 (interquartile range, 43-65) years and 76 (59%) male. Of those, 56 (44%) received broad-spectrum beta-lactams, 30 (23%) received narrow-spectrum beta-lactams, and 42 (33%) received combination therapy. After adjusting for covariates, including disease severity, combination therapy was associated with a significantly higher odds for 60-day all-cause mortality compared with broad spectrum beta-lactams (adjusted odds ratio [aOR], 3.39; 95% confidence interval [CI], 1.29-8.89; = .013) and compared with narrow spectrum beta-lactams, although the latter was not statistically significant (aOR, 3.30; 95% CI, .80-13.61; = .071).
Use of combination beta-lactam therapy in patients with MSSA BSI and febrile neutropenia is associated with a higher mortality compared with treatment with broad-spectrum beta-lactam after adjusting for potential confounders. Patients in this study who transitioned to narrow-spectrum beta-lactam antibiotics did not have worse clinical outcomes compared with those who continued broad-spectrum beta-lactam therapy.
甲氧西林敏感金黄色葡萄球菌（MSSA）是发热性中性粒细胞减少症患者血流感染（BSI）的常见病因，但治疗方法各异，且指南对于最佳治疗方案并不明确。
我们对发热性中性粒细胞减少症患者的MSSA BSI进行了一项多中心回顾性队列研究。我们将患者分为3个治疗组：（1）广谱β-内酰胺类（即哌拉西林-他唑巴坦、头孢吡肟、美罗培南）；（2）窄谱β-内酰胺类（即头孢唑林、苯唑西林、萘夫西林）；以及（3）联合β-内酰胺类（即窄谱和广谱两者联用）。我们使用多变量逻辑回归来比较60天死亡率和菌血症复发情况，同时对潜在混杂因素进行校正。
我们确定了889例MSSA BSI患者，其中128例在初次培养时存在中性粒细胞减少：中位年龄56岁（四分位间距，43 - 65岁），男性76例（59%）。其中，56例（44%）接受了广谱β-内酰胺类治疗，30例（23%）接受了窄谱β-内酰胺类治疗，42例（33%）接受了联合治疗。在校正包括疾病严重程度等协变量后，与广谱β-内酰胺类治疗相比，联合治疗与60天全因死亡率的显著更高比值相关（校正比值比[aOR]为3.39；95%置信区间[CI]为1.29 - 8.89；P = 0.013），与窄谱β-内酰胺类治疗相比，尽管后者无统计学显著性差异（aOR为3.30；95% CI为0.80 - 13.61；P = 0.071）。
在校正潜在混杂因素后，MSSA BSI和发热性中性粒细胞减少症患者使用联合β-内酰胺类治疗与使用广谱β-内酰胺类治疗相比死亡率更高。本研究中转为窄谱β-内酰胺类抗生素治疗的患者与继续使用广谱β-内酰胺类治疗的患者相比，临床结局并未更差。
