产碳青霉烯酶肠杆菌科细菌血流感染的短程治疗效果：一项回顾性队列研究。

Effectiveness of short treatment duration for carbapenemase-producing Enterobacterales in bloodstream-infections: A retrospective cohort study.

机构信息

Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.

出版信息

Int J Antimicrob Agents. 2024 Nov;64(5):107318. doi: 10.1016/j.ijantimicag.2024.107318. Epub 2024 Sep 2.

DOI:10.1016/j.ijantimicag.2024.107318

PMID:39233217

Abstract

OBJECTIVE

We analyse the effectiveness of short courses of adequate treatment in patients with episodes of carbapenemase-producing Enterobacterales bloodstream-infections (CPE-BSI).

METHODS

Patients with first monomicrobial CPE-BSI episodes who received ≥72 h of appropriate treatment from 2014-2022 were selected. Detection of CPE was established on the basis of phenotypic antibiogram and confirmation by PCR and/or immunochromatographic methods. Patients were classified in short treatment group (STG) those who received 3-10 days of appropriate treatment, and long treatment (LTG) those receiving >10 days. Unfavourable outcome consisted in a composite of global 30-day mortality and/or persistent bacteremia and/or recurrent bacteremia. Inverse probability of treatment weighting (IPTW) analysis was performed to compare the outcome between the two study groups.

RESULTS

We included 105 CPE-BSI episodes: 99 were caused by OXA-48-like, 4 VIM and 2 KPC carbapenemases. Thirty-nine patients (37.1%) were included in the STG and 66 (62.9%) in LTG. The STG group presented frequent treatment with ceftazidime-avibactam (43.6% vs. 24.2%, P = 0.03) and lower in-hospital stay (21 days vs. 32 days, P = 0.02). Overall, 28 patients (26.7%) presented unfavourable outcome: IPTW analysis showed no differences in the outcome between STG to LTG groups (24.2% vs. 30.8%, weighted-risk difference 6.6%, P = 0.44). Patients with unfavourable outcome presented more frequently source other than urinary-biliary (46.4% vs. 23.4%, P = 0.02), received less frequently ceftazidime-avibactam (14.3% vs. 37.7%, P = 0.02) and presented frequently with absence of source control when indicated (28.6% vs. 13.0%, P = 0.06).

CONCLUSIONS

Short treatment durations for CPE-BSI episodes may be effective, as long as they are appropriate and source control is performed.

摘要

目的

我们分析了碳青霉烯酶-producing Enterobacterales 血流感染（CPE-BSI）患者接受短疗程充分治疗的效果。

方法

选择 2014 年至 2022 年期间首次发生单一致病菌 CPE-BSI 且接受了≥72 小时适当治疗的患者。根据表型抗生素谱和 PCR 和/或免疫层析方法确认检测到 CPE。将接受 3-10 天适当治疗的患者分为短疗程治疗组（STG），将接受>10 天治疗的患者分为长疗程治疗组（LTG）。不良结局包括 30 天总死亡率和/或持续菌血症和/或复发性菌血症的复合指标。采用逆概率治疗加权（IPTW）分析比较两组患者的结局。

结果

共纳入 105 例 CPE-BSI 感染患者：99 例由 OXA-48 样、4 例 VIM 和 2 例 KPC 碳青霉烯酶引起。39 例（37.1%）患者被纳入 STG，66 例（62.9%）患者被纳入 LTG。STG 组经常使用头孢他啶-阿维巴坦（43.6% vs. 24.2%，P=0.03），住院时间更短（21 天 vs. 32 天，P=0.02）。总的来说，28 例患者（26.7%）出现不良结局：IPTW 分析显示 STG 和 LTG 组的结局无差异（24.2% vs. 30.8%，加权风险差异 6.6%，P=0.44）。不良结局患者的感染源更常见于非尿-胆源（46.4% vs. 23.4%，P=0.02），较少使用头孢他啶-阿维巴坦（14.3% vs. 37.7%，P=0.02），并且在需要时更常出现未控制感染源（28.6% vs. 13.0%，P=0.06）。