Propensity score-matched analysis comparing the therapeutic efficacies of cefazolin and extended-spectrum cephalosporins as appropriate empirical therapy in adults with community-onset Escherichia coli, Klebsiella spp. and Proteus mirabilis bacteraemia

被引:17
作者
Hsieh, Chih-Chia [1 ]
Lee, Chung-Hsun [1 ,2 ]
Hong, Ming-Yuan [1 ,2 ]
Hung, Yuan-Pin [2 ,3 ,4 ,5 ]
Lee, Nan-Yao [2 ,3 ,4 ]
Ko, Wen-Chien [2 ,3 ,4 ]
Lee, Ching-Chi [2 ,3 ,4 ,6 ,7 ]
机构
[1] Natl Cheng Kung Univ, Coll Med, Natl Cheng Kung Univ Hosp, Dept Emergency Med, Tainan 70403, Taiwan
[2] Natl Cheng Kung Univ, Dept Med, Coll Med, Tainan 70403, Taiwan
[3] Natl Cheng Kung Univ, Natl Cheng Kung Univ Hosp, Coll Med, Dept Internal Med, Tainan 70403, Taiwan
[4] Natl Cheng Kung Univ, Natl Cheng Kung Univ Hosp, Coll Med, Ctr Infect Control, Tainan 70403, Taiwan
[5] Minist Hlth & Welf, Tainan Hosp, Dept Internal Med, Tainan 70043, Taiwan
[6] Madou Sin Lau Hosp, Dept Internal Med, Div Crit Care Med, 20 Lingzilin, Tainan 72152, Taiwan
[7] Chang Jung Christian Univ, Coll Hlth Sci, Grad Inst Med Sci, Tainan 71101, Taiwan
关键词
Cefazolin; Extended-spectrum cephalosporin; Community-onset bacteraemia; Escherichia coli; Klebsiella spp; Proteus mirabilis; ANTIMICROBIAL SUSCEPTIBILITY; ANTIBIOTIC-THERAPY; IMPACT; ENTEROBACTERIACEAE; INFECTIONS; EPIDEMIOLOGY; CEFOTAXIME; GUIDELINES; OUTCOMES; SEPSIS;
D O I
10.1016/j.ijantimicag.2016.09.015
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
In this study, the therapeutic efficacy of cefazolin was compared with that of extended-spectrum cephalosporins (ESCs) (cefotaxime, ceftriaxone and ceftazidime) as appropriate empirical therapy in adults with community-onset monomicrobial bacteraemia caused by Escherichia coli, Klebsiella spp. or Proteus mirabilis (EKP). Compared with cefazolin-treated patients (n = 135), significantly higher proportions of patients in the ESC treatment group (n = 456) had critical illness at bacteraemia onset (Pitt bacteraemia score >= 4) and fatal co-morbidities (McCabe classification). Of the 591 patients, 121 from each group were matched using propensity score matching (PSM) based on the following independent predictors of 28-day mortality: fatal co-morbidities (McCabe classification); Pitt bacteraemia score >= 4 at bacteraemia onset; initial syndrome of septic shock; and bacteraemia due to pneumonia. After appropriate PSM, no significant differences were observed in the early clinical failure rate (10.7% vs. 7.4%; P = 0.37), the proportion of critical illness (Pitt bacteraemia score >= 4) (0% vs. 0%; P = 1.00) and defervescence (52.6% vs. 42.6%; P = 0.13) on Day 3 between the cefazolin and ESC treatment groups. Similarly, no significant differences were observed in the mean of time to defervescence (4.1 days vs. 4.9 days; P = 0.15), late clinical failure rate (18.2% vs. 10.7%; P = 0.10) and 28-day crude mortality rate (0.8% vs. 3.3%; P = 0.37) between the two groups. These data suggest that the efficacy of cefazolin is similar to that of ESCs when used as appropriate empirical antimicrobial treatment for community-onset EKP bacteraemia. (C) 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
引用
收藏
页码:712 / 718
页数:7
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