Carbapenem alternatives for treatment of bloodstream infections due to AmpC producing enterobacterales

Annals of Clinical Microbiology and Antimicrobials

Research

M. Ávila-Núñez¹  P. Rubiñán¹  M Rubianes¹  M. Represa¹  L. García-Formoso¹  P. Celestino¹  M. Garrido-Ventín¹  O. Lima²  A. Sousa²  MT. Pérez-Rodríguez²  L. Martinez-Lamas³  F. Vasallo-Vidal³  A. Pérez-Landeiro⁴ 

[1] Infectious Diseases Unit. Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Galicia, Spain;Infectious Diseases Unit. Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Galicia, Spain;Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain;Microbiology Department, Complexo Hospitalario Universitario de Vigo, Galicia, Spain;Pharmacy Department, Complexo Hospitalario Universitario de Vigo, Galicia, Spain;

关键词: Bacteremia;    Enterobacterales;    AmpC-producing;    Carbapenem;    Cefepime;    Piperacillin-tazobactam;   

DOI  :  10.1186/s12941-023-00624-9

 received in 2023-03-13, accepted in 2023-07-29,  发布年份 2023

来源: Springer

【 摘 要 】

IntroductionCarbapenems (CR) have traditionally been the first line treatment for bacteremia caused by AmpC-producing Enterobacterales. However, CR have a high ecological impact, and carbapenem-resistant strains continue rising. Thus, other treatment alternatives like Piperacillin-Tazobactam (P-T) or Cefepime (CEF) and oral sequential therapy (OST) are being evaluated.MethodsWe conducted a retrospective, single-centre observational study. All adult patients with AmpC-producing Enterobacterales bacteremia were included. The primary endpoint was clinical success defined as a composite of clinical cure, 14-day survival, and no adverse events. We evaluated the evolution of patients in whom OST was performed.ResultsSeventy-seven patients were included, 22 patients in the CR group and 55 in the P-T/CEF group (37 patients received CEF and 18 P-T). The mean age of the patients was higher in the P-T/CEF group (71 years in CR group vs. 76 years in P-T/CEF group, p = 0.053). In the multivariate analysis, age ≥ 70 years (OR 0.08, 95% CI [0.007–0.966], p = 0.047) and a Charlson index ≥ 3 (OR 0.16, 95% CI [0.026–0.984], p = 0.048), were associated with a lower clinical success. Treatment with P-T/CEF was associated with higher clinical success (OR 7.75, 95% CI [1.273–47.223], p = 0.026). OST was performed in 47% of patients. This was related with a shorter in-hospital stay (OST 14 days [7–22] vs. non-OST 18 days [13–38], p = 0.005) without difference in recurrence (OST 3% vs. non-OST 5%, p = 0.999).ConclusionsTargeted treatment with P-T/CEF and OST could be safe and effective treatments for patients with AmpC-producing Enterobacterales bacteremia.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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