Early antibiotic de-escalation in patients with severe infections due to bloodstream infection by Enterobacterales: a post-hoc analysis of a prospective multicentre cohort.
Francesc Escrihuela-Vidal, Zaira R Palacios-Baena, Josune Goikoetxea Agirre, María Teresa Pérez-Rodríguez, José María Reguera Iglesias, Jordi Cuquet Pedragosa, Leticia Sánchez Gómez, Lucía Boix-Palop, Alberto Bahamonde Carrasco, Clara Natera-Kindelán, Jonathan Fernández-Suárez, Alfredo Jover-Sáenz, Alejandro Smithson Amat, Alfonso Del Arco Jiménez, Juan Manuel Sánchez Calvo, Andrés Martín-Aspas, Pedro María Martínez Pérez-Crespo, Inmaculada López-Hernández, Jesús Rodríguez-Baño, Luis Eduardo López-Cortés
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引用次数: 0
Abstract
Background: Data about de-escalation in sepsis associated to bloodstream caused by Enterobacterales are scarce. The objectives of this study are to identify factors associated to early de-escalation and to analyse the impact of de-escalation in mortality of patients with Enterobacterales BSI with a SOFA score ≥ 2.
Material and methods: A prospective, multicenter cohort study including episodes of BSI due to Enterobacterales and SOFA score ≥2 receiving an active antipseudomonal beta-lactam was performed; the isolate should be susceptible to at least one narrower-spectrum antibiotic. Variables associated to de-escalation were identified using logistic binary regression. The association of de-escalation with 30-day mortality was investigated; confounding was controlled by calculating a propensity score used as covariate, as matching variable and for inverse probability treatment weighting (IPTW).
Results: Of 582 cases included, de-escalation was performed in 311 (53.4%). Neutropenia (adjusted OR: 0.37; 95%CI 0.18-0.75), central venous catheter (aOR: 0.52; 95%CI 0.32-0.83) and ESBL-producing isolate (aOR: 0.28; 95%CI 0.17-0.48) were negatively associated to de-escalation, and urinary tract source was positively associated (aOR: 2.27; 95%CI 1.56-3.33). Thirty-day mortality was 6.8% (21 patients) in de-escalated patients and 14.4% (39) in not de-escalated (relative risk, 0.63; 95%CI 0.44-0.89). In multivariate analysis including the propensity score, de-escalation was not associated with mortality (aOR: 0.98; 95% CI 0.39-2.47) and was protective in urinary or biliary tract source (aOR: 0.31 95%CI: 0.09-1.06). Matched and IPWT analysis showed similar results.
Conclusions: These results suggest that early de-escalation from antipseudomonal beta-lactams is safe in patients with Enterobacterales bacteremia and SOFA ≥2.
期刊介绍:
The International Journal of Antimicrobial Agents is a peer-reviewed publication offering comprehensive and current reference information on the physical, pharmacological, in vitro, and clinical properties of individual antimicrobial agents, covering antiviral, antiparasitic, antibacterial, and antifungal agents. The journal not only communicates new trends and developments through authoritative review articles but also addresses the critical issue of antimicrobial resistance, both in hospital and community settings. Published content includes solicited reviews by leading experts and high-quality original research papers in the specified fields.