Antibiotic stewardship in hematological patients with Escherichia coli and Klebsiella pneumoniae bloodstream infections: evaluating short-course and carbapenem-sparing strategies.

IF 4.6 2区医学 Q1 MICROBIOLOGY

Annals of Clinical Microbiology and Antimicrobials Pub Date : 2025-05-29 DOI:10.1186/s12941-025-00801-y

Yuqing Cui, Xiaomeng Feng, Ling Pan, Qingsong Lin, Jieru Wang, Sisi Zhen, Yuping Fan, Xin Chen, Yizhou Zheng, Yingchang Mi, Fengkui Zhang, Xiaofan Zhu, Zhijian Xiao, Erlie Jiang, Mingzhe Han, Jianxiang Wang, Sizhou Feng

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引用次数: 0

Abstract

Background: To address the overuse of antibiotics, this study examined the clinical characteristics and outcomes associated with antibiotic duration and carbapenem-sparing regimens in hematological patients with Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) bloodstream infections (BSI).

Methods: We conducted a retrospective analysis of hematological patients with E. coli or K. pneumoniae BSI from 2017 to 2023. Propensity score matching (PSM) controlled for confounding variables, and data were analyzed using multivariate regression models.

Results: A total of 1,862 patients were included (E. coli: n = 932; K. pneumoniae: n = 930). Among 1,105 patients in the antibiotic duration cohort, 48.96% (n = 541) received short-course therapy (median: 8 days, IQR: 7-9), while others received prolonged-course therapy (median: 14 days, IQR: 12-17). No significant differences in 30-day mortality or 90-day recurrence rates were observed between the two groups, either before or after PSM. In the antibiotic regimen cohort (n = 1,606), we assessed the effectiveness of carbapenem-containing versus carbapenem-sparing regimens, as well as monotherapy versus combination therapy. Among 1,488 patients with non-carbapenem-resistant Enterobacteriaceae (non-CRE) infections, 567 had infections caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria. In this subgroup, 30-day mortality rates also showed no significant differences between carbapenem-containing and carbapenem-sparing regimens, both before and after PSM.

Conclusion: In conclusion, short-course antibiotic therapy is as effective as prolonged therapy for treating E. coli and K. pneumoniae BSI in hematological patients. Similarly, carbapenem-sparing regimens are non-inferior to carbapenem-based regimens. These findings highlight the potential for optimizing antibiotic use, but further validation through randomized controlled trials is warranted.

查看原文本刊更多论文

血液病患者的抗生素管理与大肠杆菌和肺炎克雷伯菌血液感染：评估短期和碳青霉烯节约策略。

背景：为了解决抗生素的过度使用问题，本研究调查了大肠杆菌（E. coli）和肺炎克雷伯菌（K. pneumoniae）血液感染（BSI）血液病患者的临床特征和与抗生素持续时间和碳青霉烯节约方案相关的结果。方法：回顾性分析2017 - 2023年感染大肠杆菌或肺炎克雷伯菌BSI的血液学患者。倾向得分匹配（PSM）控制混杂变量，数据分析采用多元回归模型。结果：共纳入1862例患者(大肠杆菌：n = 932；肺炎克雷伯菌：n = 930)。在抗生素持续时间队列的1105例患者中，48.96% （n = 541）接受了短期治疗（中位数：8天，IQR: 7-9），而其他患者接受了长期治疗（中位数：14天，IQR: 12-17）。两组在PSM前后的30天死亡率和90天复发率均无显著差异。在抗生素方案队列（n = 1,606）中，我们评估了含碳青霉烯与保留碳青霉烯方案的有效性，以及单药治疗与联合治疗的有效性。在1488例非碳青霉烯耐药肠杆菌科（non-CRE）感染患者中，567例感染由广谱β -内酰胺酶（ESBL）产生菌引起。在这个亚组中，含碳青霉烯和保留碳青霉烯方案在PSM前后的30天死亡率也没有显着差异。结论：短期抗生素治疗血液病患者大肠杆菌和肺炎克雷伯菌BSI与长期抗生素治疗效果相同。同样，保留碳青霉烯的方案也不逊于以碳青霉烯为基础的方案。这些发现强调了优化抗生素使用的潜力，但需要通过随机对照试验进一步验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Clinical Microbiology and Antimicrobials MICROBIOLOGY-

CiteScore

8.60

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Annals of Clinical Microbiology and Antimicrobials considers good quality, novel and international research of more than regional relevance. Research must include epidemiological and/or clinical information about isolates, and the journal covers the clinical microbiology of bacteria, viruses and fungi, as well as antimicrobial treatment of infectious diseases. Annals of Clinical Microbiology and Antimicrobials is an open access, peer-reviewed journal focusing on information concerning clinical microbiology, infectious diseases and antimicrobials. The management of infectious disease is dependent on correct diagnosis and appropriate antimicrobial treatment, and with this in mind, the journal aims to improve the communication between laboratory and clinical science in the field of clinical microbiology and antimicrobial treatment. Furthermore, the journal has no restrictions on space or access; this ensures that the journal can reach the widest possible audience.