Medical Sciences Post-Graduation Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Department of Internal Medicine, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
J Antimicrob Chemother. 2022 Oct 28;77(11):3118-3125. doi: 10.1093/jac/dkac292.
To investigate the effect of double-, single- and none-carbapenem-containing antimicrobial regimens in the treatment of patients with carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs).
We conducted a retrospective cohort study from 2013 to 2020 in two Brazilian hospitals. Patients ≥18 years old with CRE BSI were included and excluded if death or treatment duration for ≤48 h after BSI or non-Class A-producing carbapenemase isolates. We evaluated the impact of different carbapenem-containing regimens on 30 day mortality through a propensity score adjusted model and a Cox proportional hazards model.
Two-hundred and seventy-nine patients were included for analyses: 47 (16.9%), 149 (53.4%) and 83 (29.8%) were treated with double-, single- and none-carbapenem-containing regimens, respectively. One-hundred and seventeen (41.9%) patients died in 30 days. Treatment with a single-carbapenem regimen was associated with a lower risk of death in 30 days compared with therapies containing no carbapenem [adjusted HR (aHR) 0.66, 95% CI 0.44-0.99, P = 0.048], when adjusted for Charlson score and ICU admission at baseline, while double-carbapenem regimens were not associated with a lower risk of death (aHR 0.78, 95% CI 0.46-1.32, P = 0.35). Propensity score adjusted model results went in the same direction.
Double-carbapenem- was not superior to single-carbapenem-containing regimens in patients with CRE BSIs. Single-carbapenem-containing schemes were associated with a lower mortality risk.
研究含双碳青霉烯、单碳青霉烯和无碳青霉烯的抗菌方案在治疗碳青霉烯耐药肠杆菌科（CRE）血流感染（BSI）患者中的效果。
我们在巴西的两家医院进行了一项回顾性队列研究，纳入了年龄≥18 岁、CRE BSI 患者，并排除了 BSI 后死亡或治疗持续时间≤48 小时或非 A 类产碳青霉烯酶分离株的患者。我们通过倾向评分调整模型和 Cox 比例风险模型评估了不同含碳青霉烯方案对 30 天死亡率的影响。
共纳入 279 例患者进行分析：47 例（16.9%）、149 例（53.4%）和 83 例（29.8%）分别接受了双碳青霉烯、单碳青霉烯和无碳青霉烯方案治疗。117 例（41.9%）患者在 30 天内死亡。与无碳青霉烯治疗相比，单碳青霉烯方案治疗在 30 天内死亡的风险较低（调整后的 HR（aHR）0.66，95%CI 0.44-0.99，P=0.048），调整了基线时的 Charlson 评分和 ICU 入院率，而双碳青霉烯方案与死亡风险降低无关（aHR 0.78，95%CI 0.46-1.32，P=0.35）。倾向评分调整模型的结果方向相同。
在 CRE BSI 患者中，双碳青霉烯方案并不优于单碳青霉烯方案。含单碳青霉烯方案与较低的死亡率风险相关。
