从头孢曲松转为头孢噻肟对第三代头孢菌素耐药肠杆菌的影响：一项阶梯楔形群随机试验。

IF 2.9 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now Pub Date : 2023-10-12 DOI:10.1016/j.idnow.2023.104806

Kevin Bouiller , Houssein Gbaguidi-Haore , Didier Hocquet , Thomas Crépin , Daniel Wendling , Sophie Borot , Catherine Chirouze , Xavier Bertrand

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引用次数: 0

摘要

目的：评价头孢噻肟替代头孢曲松对第三代头孢菌素耐药肠杆菌病（3GC-RE）发生率的影响。患者和方法：我们进行了一项为期24个月的单中心前瞻性阶梯楔形群随机对照试验。在研究的对照阶段，临床医生开了头孢曲松或头孢噻肟。在干预阶段，他们系统地开了头孢噻肟。结果：头孢噻肟/头孢曲松比值与3GC-RE的发生率呈负相关。总之，在控制阶段，3GC-RE的发病率为1.05（27/25692）获得性病例/1000住院天数，在干预阶段为0.54（11/20419）获得性案例/1000住院天数（发病率比率[IRR]=0.51[0.22-1.07]，p=0.06）。在多变量分析中，干预阶段（与控制阶段）（p=0.007），头孢噻肟/头孢曲松比值（p=0.003）和进口3GC-RE（p=0.005）与获得性3GC-RE的发生率相关。结论：我们发现用头孢噻肟代替头孢曲松可以减少3GC-RE分离株的发生。需要更多的研究来证实这些结果。

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The effects of switching from ceftriaxone to cefotaxime on the occurrence of third-generation cephalosporin-resistant Enterobacterales: A stepped-wedge cluster randomized trial

Objectives

To evaluate the effects of the replacement of ceftriaxone by cefotaxime on the incidence of third-generation cephalosporin-resistant Enterobacterales (3GC-RE).

Patients and methods

We conducted a 24-month monocentric prospective, stepped-wedge cluster randomized controlled trial. During the control phase of the study, clinicians prescribed either ceftriaxone or cefotaxime. During the intervention phase, they systematically prescribed cefotaxime.

Results

The cefotaxime/ceftriaxone ratio was inversely correlated with the incidence of 3GC-RE. All in all, 3GC-RE incidence was 1.05 (27/25,692) acquired cases/1000 hospitalization days during the control phase and 0.54 (11/20,419) acquired cases/1000 hospitalization days during the intervention phase (incidence rate ratio [IRR] = 0.51 [0.22–1.07], p = 0.06). In multivariable analysis, intervention phase (versus control phase) (p = 0.007), cefotaxime/ceftriaxone ratio (p = 0.003) and imported 3GC-RE (p = 0.005) were associated with the incidence of acquired cases of 3GC-RE.