Amy Y Kang, Mary Elkomos, Danny Pham, Michelle Guerrero, Deborah Kupferwasser, Loren G Miller
{"title":"在非重症监护病房患者中使用碳青霉烯类与非碳青霉烯类经验疗法治疗产扩展谱β-内酰胺酶肠杆菌感染的效果:在一家产扩展谱β-内酰胺酶肠杆菌感染率较高的医院进行的实际调查。","authors":"Amy Y Kang, Mary Elkomos, Danny Pham, Michelle Guerrero, Deborah Kupferwasser, Loren G Miller","doi":"10.1017/ash.2024.88","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether empiric carbapenem therapy, compared to empiric non-carbapenem therapy, was associated with improved clinical outcomes among hospitalized, non-intensive care unit (ICU) patients with extended-spectrum β-lactamase (ESBL)-producing Enterobacterales infections.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of adult, non-ICU patients admitted with ESBL-producing Enterobacterales infections. Primary outcome was time to clinical stability from the first empiric antibiotic dose. Secondary outcomes were early clinical response and 30-day all-cause hospital readmission. We used multivariate regression methods to examine time to clinical stability.</p><p><strong>Results: </strong>Of the 142 patients, 59 (42%) received empiric carbapenems and 83 (58%) received empiric non-carbapenems, most commonly ceftriaxone (49/83, 59%). Median age was 59 years. The most common infection source was urinary (71%). The carbapenem group had a higher proportion of patients who received antibiotics within 6 months of admission (55% vs 28%, <i>P</i> < .01) and history of ESBL (57% vs 17%, <i>P</i> < .01). There were no significant differences in hours until clinical stability between the carbapenem and non-carbapenem groups (22 (IQR: 0, 85) vs 19 (IQR: 0, 69), <i>P</i> = .54). Early clinical response (88% vs 90%, <i>P</i> = .79) and 30-day all-cause hospital readmission (17% vs 8%, <i>P</i> = .13) were similar between groups.</p><p><strong>Conclusion: </strong>Among hospitalized non-ICU patients with ESBL-producing Enterobacterales infection, we found no difference in time to clinical stability after the first empiric antibiotic dose between those receiving carbapenems and those who did not. Our data suggest that empiric carbapenem use may not be an important driver of clinical response in patients with less severe ESBL-producing Enterobacterales infection.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149041/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effectiveness of empiric carbapenem versus non-carbapenem therapy for extended-spectrum β-lactamase producing Enterobacterales infections in non-intensive care unit patients: a real-world investigation in a hospital with high-prevalence of extended-spectrum β-lactamase producing Enterobacterales.\",\"authors\":\"Amy Y Kang, Mary Elkomos, Danny Pham, Michelle Guerrero, Deborah Kupferwasser, Loren G Miller\",\"doi\":\"10.1017/ash.2024.88\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To investigate whether empiric carbapenem therapy, compared to empiric non-carbapenem therapy, was associated with improved clinical outcomes among hospitalized, non-intensive care unit (ICU) patients with extended-spectrum β-lactamase (ESBL)-producing Enterobacterales infections.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of adult, non-ICU patients admitted with ESBL-producing Enterobacterales infections. Primary outcome was time to clinical stability from the first empiric antibiotic dose. Secondary outcomes were early clinical response and 30-day all-cause hospital readmission. We used multivariate regression methods to examine time to clinical stability.</p><p><strong>Results: </strong>Of the 142 patients, 59 (42%) received empiric carbapenems and 83 (58%) received empiric non-carbapenems, most commonly ceftriaxone (49/83, 59%). Median age was 59 years. The most common infection source was urinary (71%). The carbapenem group had a higher proportion of patients who received antibiotics within 6 months of admission (55% vs 28%, <i>P</i> < .01) and history of ESBL (57% vs 17%, <i>P</i> < .01). There were no significant differences in hours until clinical stability between the carbapenem and non-carbapenem groups (22 (IQR: 0, 85) vs 19 (IQR: 0, 69), <i>P</i> = .54). Early clinical response (88% vs 90%, <i>P</i> = .79) and 30-day all-cause hospital readmission (17% vs 8%, <i>P</i> = .13) were similar between groups.</p><p><strong>Conclusion: </strong>Among hospitalized non-ICU patients with ESBL-producing Enterobacterales infection, we found no difference in time to clinical stability after the first empiric antibiotic dose between those receiving carbapenems and those who did not. Our data suggest that empiric carbapenem use may not be an important driver of clinical response in patients with less severe ESBL-producing Enterobacterales infection.</p>\",\"PeriodicalId\":72246,\"journal\":{\"name\":\"Antimicrobial stewardship & healthcare epidemiology : ASHE\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-06-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149041/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Antimicrobial stewardship & healthcare epidemiology : ASHE\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1017/ash.2024.88\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Antimicrobial stewardship & healthcare epidemiology : ASHE","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1017/ash.2024.88","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的研究经验性碳青霉烯类疗法与经验性非碳青霉烯类疗法相比,是否能改善非重症监护病房(ICU)住院的产扩展谱β-内酰胺酶(ESBL)肠杆菌感染患者的临床预后:我们对因产 ESBL 肠杆菌感染而入住非重症监护病房的成人患者进行了一项回顾性队列研究。主要结果是从首次使用经验性抗生素到临床稳定的时间。次要结果是早期临床反应和 30 天全因再住院率。我们采用多变量回归方法来检验临床稳定时间:在142名患者中,59人(42%)接受了碳青霉烯类经验性治疗,83人(58%)接受了非碳青霉烯类经验性治疗,其中最常见的是头孢曲松(49/83,59%)。中位年龄为 59 岁。最常见的感染源是泌尿系统(71%)。碳青霉烯类药物组患者在入院后6个月内接受抗生素治疗的比例更高(55% vs 28%,P < .01),ESBL病史更长(57% vs 17%,P < .01)。碳青霉烯类药物组和非碳青霉烯类药物组患者的临床稳定时间无明显差异(22(IQR:0,85)vs 19(IQR:0,69),P = .54)。两组的早期临床反应(88% vs 90%,P = .79)和30天全因再入院率(17% vs 8%,P = .13)相似:结论:在非重症监护病房的ESBL产肠杆菌感染住院患者中,我们发现接受和未接受碳青霉烯类抗生素治疗的患者在首次使用经验性抗生素后达到临床稳定的时间上没有差异。我们的数据表明,对于病情较轻的产 ESBL 肠杆菌感染患者来说,经验性使用碳青霉烯类抗生素可能不是影响临床反应的重要因素。
Effectiveness of empiric carbapenem versus non-carbapenem therapy for extended-spectrum β-lactamase producing Enterobacterales infections in non-intensive care unit patients: a real-world investigation in a hospital with high-prevalence of extended-spectrum β-lactamase producing Enterobacterales.
Objective: To investigate whether empiric carbapenem therapy, compared to empiric non-carbapenem therapy, was associated with improved clinical outcomes among hospitalized, non-intensive care unit (ICU) patients with extended-spectrum β-lactamase (ESBL)-producing Enterobacterales infections.
Methods: We performed a retrospective cohort study of adult, non-ICU patients admitted with ESBL-producing Enterobacterales infections. Primary outcome was time to clinical stability from the first empiric antibiotic dose. Secondary outcomes were early clinical response and 30-day all-cause hospital readmission. We used multivariate regression methods to examine time to clinical stability.
Results: Of the 142 patients, 59 (42%) received empiric carbapenems and 83 (58%) received empiric non-carbapenems, most commonly ceftriaxone (49/83, 59%). Median age was 59 years. The most common infection source was urinary (71%). The carbapenem group had a higher proportion of patients who received antibiotics within 6 months of admission (55% vs 28%, P < .01) and history of ESBL (57% vs 17%, P < .01). There were no significant differences in hours until clinical stability between the carbapenem and non-carbapenem groups (22 (IQR: 0, 85) vs 19 (IQR: 0, 69), P = .54). Early clinical response (88% vs 90%, P = .79) and 30-day all-cause hospital readmission (17% vs 8%, P = .13) were similar between groups.
Conclusion: Among hospitalized non-ICU patients with ESBL-producing Enterobacterales infection, we found no difference in time to clinical stability after the first empiric antibiotic dose between those receiving carbapenems and those who did not. Our data suggest that empiric carbapenem use may not be an important driver of clinical response in patients with less severe ESBL-producing Enterobacterales infection.