Does Quick Sepsis-Related Organ Failure Assessment Suggest the Use of Initial Empirical Carbapenem Therapy in Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Bacteria? :A Multicenter Case-Control Study

Japanese journal of infectious diseases

Kenichi Kobayashi¹  Naoki Tsuruma²  Satoru Mitsuboshi³  Kazuya Watanabe⁴  Atsuko Ito⁵  Manami Nakashita⁶  Shigehiro Takahashi⁷ 

[1] Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences;Department of Pharmacy, JA Niigata Kouseiren Sado General Hospital;Department of Pharmacy, Kaetsu Hospital;Department of Pharmacy, Kashiwazaki General Hospital and Medical Center;Department of Pharmacy, Nagaoka Red Cross Hospital;Department of Pharmacy, Niigata City General Hospital;Department of Pharmacy, Saiseikai Niigata Daini Hospital

关键词: extended-spectrum β-lactamase;    bacteremia;    carbapenem;    quick sequential organ failure assessment;   

DOI  :  10.7883/yoken.JJID.2018.272

学科分类：传染病学

来源: National Institute of Infectious Diseases

【 摘 要 】

We hypothesized that quick Sequential Organ Failure Assessment (qSOFA) would be associated with 30-day mortality in bacteremia caused by extended-spectrum β-lactamase (ESBL)-producing bacteria and might be a selection criterion for the use of carbapenem as initial empirical therapy. A multicenter retrospective study was conducted in six hospitals. All patients who had bacteremia due to ESBL-producing bacteria were included in the study. Multivariable logistic regression analysis was performed to analyze 30-day mortality as the main outcome. A total of 203 adult patients were identified with bacteremia caused by ESBL-producing Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis. In multivariate logistic regression analysis, bacteremia caused by ESBL-producing K. pneumoniae or P. mirabilis (odds ratio [OR] 5.07, 95% confidence interval [CI] 1.64–15.56), underlying liver disease (OR 3.38, 95% CI 1.09–10.00), and underlying solid cancer (OR 3.45, 95% CI 1.27–9.69) were associated with 30-day mortality. In a subgroup analysis, empirical non-carbapenem therapy was associated with 30-day mortality in bacteremia caused by ESBL-producing K. pneumoniae or P. mirabilis. Our results suggest that the qSOFA score is not a selection criterion for the use of carbapenem in initial empirical therapy.

【 授权许可】

Unknown