Atamna Alaa, Wazana Yaara, Ben-Zvi Haim, Shochat Tzippy, Bishara Jihad, Nutman Amir
Infectious Diseases Unit, Beilinson Hospital, Rabin Medical Center, Petah-Tikva 491000, Israel.
Gray Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv 6997801, Israel.
J Clin Med. 2025 Sep 15;14(18):6485. doi: 10.3390/jcm14186485.
Carbapenem-resistant (CRAB) bacteremia is a critical health concern associated with high morbidity and mortality and limited treatment options. Whether early initiation of concordant antibiotic therapy upon recognition of sepsis improves outcomes remains unclear. : We conducted a retrospective cohort study of 413 patients diagnosed with CRAB bacteremia to evaluate the impact of early concordant antibiotic treatment (i.e., administration of in vitro active antibiotics within 24 h of blood culture collection) on 30-day mortality. Multivariable logistic regression was conducted to identify predictors of early concordant treatment and to evaluate its association with 30-day mortality. To address potential confounding by early death, a sensitivity analysis was performed which included only patients who survived at least 48 h after blood culture collection. : Among the study cohort, 30% (122/413) received early concordant treatment (all received colistin), while 70% (291/413) received early discordant treatment. The median age of patients receiving early concordant treatment was 69 (interquartile range (IQR), 62-78) years vs. 71 (IQR, 62-81) years in the discordant group ( = 0.1). Patients who received early concordant treatment were more likely to be mechanically ventilated (52% vs. 40%, = 0.03) and have rectal carriage of multidrug-resistant bacteria (16% vs. 9%, = 0.06). The 30-day mortality was 63% (260/413). In univariate analysis, survivors were more likely to have received early concordant treatment (38% vs. 25%, = 0.005); however, this association was not statistically significant in the multivariable model (adjusted odds ratio [aOR] 0.36, 95% confidence interval [CI] 0.13-1.02, = 0.053). Significant factors associated with 30-day mortality included age ≥65 years (aOR 4; 95% CI 1.1-17, = 0.04) and SOFA score ≥5 points (aOR 7.14; 95% CI 2-25, < 0.01). In the sensitivity analysis limited to patients who survived at least 48 h after blood culture collection, early concordant treatment remained unassociated with 30-day mortality (aOR 1.8; 95% CI 0.5-7, = 0.4). : Early concordant antibiotic treatment was not significantly associated with 30-day mortality in patients with CRAB bacteremia. Older age and SOFA score were significant predictors of mortality. Whether this finding reflects the limited efficacy of colistin, which was the predominant empiric antibiotic in this cohort, remains unclear; nevertheless, more effective therapeutic options for CRAB bacteremia are urgently needed to improve patient outcomes.
耐碳青霉烯类（CRAB）菌血症是一个严重的健康问题，与高发病率、高死亡率以及有限的治疗选择相关。在识别出脓毒症后尽早开始使用合适的抗生素治疗是否能改善预后仍不明确。我们对413例被诊断为CRAB菌血症的患者进行了一项回顾性队列研究，以评估早期使用合适抗生素治疗（即在血培养采集后24小时内给予体外活性抗生素）对30天死亡率的影响。进行多变量逻辑回归以确定早期使用合适治疗的预测因素，并评估其与30天死亡率的关联。为解决早期死亡可能造成的混杂问题，进行了一项敏感性分析，该分析仅纳入血培养采集后至少存活48小时的患者。在研究队列中，30%（122/413）接受了早期合适治疗（均接受了黏菌素治疗），而70%（291/413）接受了早期不合适治疗。接受早期合适治疗的患者中位年龄为69岁（四分位间距[IQR]，62 - 78岁），而不合适治疗组为71岁（IQR，62 - 81岁）（P = 0.1）。接受早期合适治疗的患者更有可能接受机械通气（52%对40%，P = 0.03）且直肠携带多重耐药菌（16%对9%，P = 0.06）。30天死亡率为63%（260/413）。在单变量分析中，幸存者更有可能接受了早期合适治疗（38%对25%，P = 0.005）；然而，在多变量模型中这种关联无统计学意义（调整优势比[aOR] 0.36，95%置信区间[CI] 0.13 - 1.02），P = 0.053）。与30天死亡率相关的显著因素包括年龄≥65岁（aOR 4；95% CI 1.1 - 17，P = 0.04）和序贯器官衰竭评估（SOFA）评分≥5分（aOR 7.14；95% CI 2 - 25，P < 0.01）。在仅限于血培养采集后至少存活48小时患者的敏感性分析中，早期合适治疗仍与30天死亡率无关（aOR 1.8；95% CI 0.5 - 7，P = 0.4）。早期使用合适抗生素治疗与CRAB菌血症患者的30天死亡率无显著关联。年龄较大和SOFA评分是死亡率的显著预测因素。这一发现是否反映了黏菌素（该队列中主要的经验性抗生素）疗效有限尚不清楚；尽管如此，迫切需要更有效的CRAB菌血症治疗选择以改善患者预后。
