Eudy Joshua, Chase Aaron M, Sharma Divisha, Sulaiman Zoheb Irshad, Anderson August, Huggett Ashley, Gloe Lucy, Anderson Daniel T
Department of Pharmacy, Wellstar MCG Health, Augusta, GA 30912, USA.
Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA 30602, USA.
Antibiotics (Basel). 2025 May 13;14(5):497. doi: 10.3390/antibiotics14050497.
: Gram-negative bloodstream infections (GN-BSIs) in the critically ill carry significant mortality, which is exacerbated by delays in appropriate therapy. To improve the time to effective therapy, aminoglycosides are often recommended as empiric adjunctive antimicrobials. However, there is a paucity of clinical data supporting this practice. This study's objective was to evaluate the safety and efficacy of adjunctive aminoglycosides compared to β-lactam monotherapy in patients admitted to the intensive care unit (ICU) with GN-BSI. : This was a retrospective, propensity-matched cohort study of critically ill patients with GN-BSI. The primary outcome was 15-day all-cause mortality. The secondary endpoints evaluated included 30-day mortality, ICU-free survival days, 60-day relapse, 30-day readmission, development of acute kidney injury (AKI), and new resistance. : A total of 209 propensity-matched patients were included for analysis: 136 received β-lactam monotherapy and 73 received adjunctive aminoglycoside. The primary outcome of 15-day all-cause mortality was not significantly different between groups (17% vs. 21%; = 0.644). Additional secondary endpoints of 30-day mortality (22% vs. 25%), ICU-free survival (12.1 vs. 12.2 days), 60-day relapse (3.3% vs. 7.4%), and 30-day readmission (23% vs. 18%) did not yield significant differences. The proportion of AKI was higher in the adjunctive aminoglycoside group but was not found to be significantly different (26.5% vs. 37%). : The use of adjunctive aminoglycosides for GN-BSI did not affect clinical outcomes in the critically ill.
危重症患者的革兰阴性菌血流感染（GN-BSIs）死亡率很高，而不适当治疗的延迟会加剧这种情况。为了缩短有效治疗时间，氨基糖苷类药物常被推荐作为经验性辅助抗菌药物。然而，支持这种做法的临床数据很少。本研究的目的是评估在重症监护病房（ICU）收治的GN-BSI患者中，辅助使用氨基糖苷类药物与β-内酰胺类单药治疗相比的安全性和有效性。 ：这是一项对患有GN-BSI的危重症患者进行的回顾性、倾向匹配队列研究。主要结局是15天全因死亡率。评估的次要终点包括30天死亡率、无ICU生存天数、60天复发率、30天再入院率、急性肾损伤（AKI）的发生情况以及新出现的耐药性。 ：共有209例倾向匹配患者纳入分析：136例接受β-内酰胺类单药治疗，73例接受辅助氨基糖苷类药物治疗。两组之间15天全因死亡率的主要结局无显著差异（17%对21%；P = 0.644）。30天死亡率（22%对25%）、无ICU生存（12.1天对12.2天）、60天复发率（3.3%对7.4%）和30天再入院率（23%对18%）等其他次要终点也无显著差异。辅助氨基糖苷类药物组的AKI发生率较高，但未发现有显著差异（26.5%对37%）。 ：辅助使用氨基糖苷类药物治疗GN-BSI对危重症患者的临床结局没有影响。
