Institute for Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.
Public Health Ontario, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Clin Microbiol Infect. 2023 Apr;29(4):490-497. doi: 10.1016/j.cmi.2022.10.004. Epub 2022 Oct 7.
In this study, we evaluated the clinical outcomes associated with the use of highly bioavailable oral antibiotics (fluoroquinolones and trimethoprim-sulfamethoxazole) compared with the less-bioavailable oral antibiotics (β-lactams) in gram-negative bloodstream infections (BSIs).
Among hospitalized older adult patients in Ontario, Canada, discharged home on oral treatment for gram-negative BSI between 1 January 2017 and 31 December 2019, we used a matched cohort design to compare outcomes among those receiving highly versus less-bioavailable agents; hard-matching 1:1 on sex, BSI pathogen (Escherichia coli vs. non-E. coli), and infection source (urinary vs. non-urinary/unknown source) along with a propensity score, incorporating specific pathogen, patient, and infection characteristics. The primary outcome was the composite of 90-day all-cause mortality, recurrent BSI with the same pathogen (genus and species), and re-admission to any Ontario hospital.
A total of 2012 patients were included in the study (1006 in each bioavailability category). Those who received highly (compared with less) bioavailable antibiotics at discharge had lower rates of the composite outcome (171/1006 [17.0%] vs. 216/1006 [21.5%]), adjusted odds ratio being 0.74 (95% CI, 0.60-0.92). Recurrent BSI at 90 days was the main driver for the composite outcome occurring in 64 (5.4%) and 107 (9.4%) patients of the highly and less-bioavailable groups, respectively (p < 0.001) (adjusted odds ratio, 0.56; 95% CI, 0.40-0.78).
Use of highly (compared with less) bioavailable antibiotics at discharge was associated with significantly better clinical outcomes among patients with gram-negative BSIs.
本研究评估了与使用生物利用度较低的口服抗生素（β-内酰胺类）相比，高生物利用度口服抗生素（氟喹诺酮类和复方磺胺甲噁唑）治疗革兰氏阴性菌血流感染（BSI）的临床结局。
在加拿大安大略省，对 2017 年 1 月 1 日至 2019 年 12 月 31 日期间出院并接受口服治疗革兰氏阴性菌 BSI 的住院老年患者，采用匹配队列设计比较高生物利用度与低生物利用度药物治疗组的结局；在性别、BSI 病原体（大肠埃希菌与非大肠埃希菌）和感染源（尿源与非尿源/未知源）方面进行 1:1 硬匹配，并结合倾向性评分，纳入特定病原体、患者和感染特征。主要结局为 90 天全因死亡率、相同病原体（属和种）复发性 BSI 和任何安大略省医院再入院的复合结局。
共纳入 2012 例患者（高生物利用度组和低生物利用度组各 1006 例）。出院时使用高（低）生物利用度抗生素的患者复合结局发生率较低（171/1006 [17.0%] vs. 216/1006 [21.5%]），调整后比值比为 0.74（95%CI，0.60-0.92）。90 天内复发性 BSI 是导致复合结局的主要原因，高生物利用度组和低生物利用度组分别有 64 例（5.4%）和 107 例（9.4%）患者发生（p<0.001）（调整后比值比，0.56；95%CI，0.40-0.78）。
与使用生物利用度较低的抗生素相比，出院时使用高生物利用度抗生素与革兰氏阴性菌 BSI 患者的临床结局显著改善相关。
