Pallotto Carlo, Tommasi Andrea, Svizzeretto Elisabetta, Genga Giovanni, Gamboni Giulia, Gidari Anna, Francisci Daniela
Infectious Diseases Clinic, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, 06132 Perugia, Italy.
Infectious Diseases Clinic, Santa Maria Hospital, Department of Medicine, University of Perugia, 05100 Terni, Italy.
Infect Dis Rep. 2024 Aug 27;16(5):828-835. doi: 10.3390/idr16050064.
is one of the major concerns among bacterial diseases even when it shows a wild-type susceptibility pattern. In 2020, EUCAST reconsidered antibiogram interpretation shifting "I" from "intermediate" to "sensible, increased exposure" with possible significant impact on antibiotic prescription. The aim of this study was to evaluate mortality in patients with bloodstream infections treated with antipseudomonal penicillins or cephalosporins vs. carbapenems and ceftazidime/avibactam.
This is a retrospective observational study. All the patients with a bloodstream infection due to admitted to our hospital were enrolled. Exclusion criteria were as follows: extremely critical conditions, age <18 years, pregnancy, isolation of a strain non-susceptible to piperacillin/tazobactam and antipseudomonal cephalosporins. Patients were divided into group A (treatment with carbapenems or ceftazidime/tazobactam) and group B (treatment with antipseudomonal penicillin or cephalosporins).
We enrolled 77 patients, 56 and 21 in groups A and B, respectively. The two groups were homogeneous for age, sex, and biochemical and clinical characteristics at admission. All-cause in-hospital mortality was 17/56 (30.4%) and 3/21 (14.3%) in groups A and B, respectively ( > 0.1). In group A, in-hospital BSI-related mortality was 23.2% (13/56), while it was 14.3% (3/21) in group B ( > 0.1). After multivariate analysis, only the PITT score represented a risk factor for BSI-related mortality (OR 2.917, 95% CI 1.381-6.163).
Both all-cause and BSI-related mortality were comparable between the two groups. Treatment with carbapenem or ceftazidime/avibactam did not represent a protective factor for mortality in wild-type BSI.
即使表现出野生型药敏模式，[细菌名称未给出]也是细菌性疾病中的主要关注点之一。2020年，欧洲抗菌药物敏感性试验委员会（EUCAST）重新考虑了抗菌谱解释，将“I”从“中介”改为“敏感，增加暴露”，这可能会对抗生素处方产生重大影响。本研究的目的是评估接受抗假单胞菌青霉素或头孢菌素治疗与接受碳青霉烯类和头孢他啶/阿维巴坦治疗的血流感染患者的死亡率。
这是一项回顾性观察研究。纳入所有因[细菌名称未给出]导致血流感染并入住我院的患者。排除标准如下：病情极其危急、年龄<18岁、怀孕、分离出对哌拉西林/他唑巴坦和抗假单胞菌头孢菌素不敏感的菌株。患者分为A组（接受碳青霉烯类或头孢他啶/他唑巴坦治疗）和B组（接受抗假单胞菌青霉素或头孢菌素治疗）。
我们纳入了77例患者，A组和B组分别为56例和21例。两组在年龄、性别以及入院时的生化和临床特征方面具有同质性。A组和B组的全因院内死亡率分别为17/56（30.4%）和3/21（14.3%）（P>0.1）。在A组中，院内血流感染相关死亡率为23.2%（13/56），而B组为14.3%（3/21）（P>0.1）。多因素分析后，只有PITT评分是血流感染相关死亡率的危险因素（比值比2.917，95%置信区间1.381 - 6.163）。
两组的全因死亡率和血流感染相关死亡率相当。在野生型[细菌名称未给出]血流感染中，使用碳青霉烯类或头孢他啶/阿维巴坦治疗并非死亡率的保护因素。
