Impact of the Inclusion of an Aminoglycoside to the Initial Empirical Antibiotic Therapy for Gram-Negative Bloodstream Infections in Hematological Neutropenic Patients: a PropensityMatched Cohort Study (AMINOLACTAM Study)

被引：37

作者：

Albasanz-Puig, A. ^{[1
,2
,3
]}

Gudiol, C. ^{[1
,2
,3
,4
,5
]}

Puerta-Alcalde, P. ^{[3
,6
]}

Ayaz, C. M. ^{[7
]}

Machado, M. ^{[8
]}

Herrera, F. ^{[9
]}

Martin-Davila, P. ^{[10
]}

Laporte-Amargos, J. ^{[1
,2
,3
]}

Cardozo, C. ^{[6
]}

Akova, M. ^{[7
]}

Alvarez-Uria, A. ^{[8
]}

Torres, D. ^{[9
]}

Fortun, J. ^{[10
]}

Garcia-Vidal, C. ^{[3
,6
]}

Munoz, P. ^{[8
]}

Bergas, A. ^{[1
]}

Pomares, H. ^{[11
]}

Mercadal, S. ^{[11
]}

Dura-Miralles, X. ^{[1
,2
,3
]}

Garcia-Lerma, E. ^{[12
]}

Pallares, N. ^{[12
]}

Carratala, J. ^{[1
,2
,3
,4
]}

机构：

[1] Bellvitge Univ Hosp, Infect Dis Dept, Barcelona, Spain

[2] Inst Invest Biomed Bellvitge, Infect Dis & Transplantat Program, Infect Resp Tract & Immunocompromised Patients Re, Barcelona, Spain

[3] Inst Salud Carlos III, Spanish Network Res Infect Dis, Madrid, Spain

[4] Univ Barcelona, Barcelona, Spain

[5] Inst Catala Oncol, Barcelona, Spain

[6] Hosp Clin Barcelona, Infect Dis Dept, Barcelona, Spain

[7] Hacettepe Univ, Sch Med, Ankara, Turkey

[8] Hosp Gen Univ Gregorio Maranon, Clin Microbiol & Infect Dis Dept, Madrid, Spain

[9] Ctr Educ Med & Invest Clin, Dept Med, Infect Dis Sect, Buenos Aires, DF, Argentina

[10] Ramon & Cajal Hosp, Infect Dis Dept, Madrid, Spain

[11] Inst Catala Oncol, Hematol Dept, Barcelona, Spain

[12] Inst Invest Biomed Bellvitge, Biostat Unit, Barcelona, Spain

来源：

ANTIMICROBIAL AGENTS AND CHEMOTHERAPY | 2021年 / 65卷 / 08期

关键词：

febrile neutropenia; hematological patients; aminoglycosides; combination empirical treatment; Gram-negative bloodstream infection; BETA-LACTAM; PSEUDOMONAS-AERUGINOSA; SEPTIC SHOCK; BACTEREMIA; MONOTHERAPY; GUIDELINES; RESISTANCE; MORTALITY; AGENTS; CARE;

D O I：

10.1128/AAC.00045-21

中图分类号：

Q93 [微生物学];

学科分类号：

071005 ; 100705 ;

摘要：

To test the hypothesis that the addition of an aminoglycoside to a beta-lactam antibiotic could provide better outcomes than beta-lactam monotherapy for the initial empirical treatment of hematological neutropenic patients with subsequently documented Gram-negative bacillus (GNB) bloodstream infection (BSI), a multinational, retrospective, cohort study of GNB BSI episodes in hematological neutropenic patients in six centers (2010 to 2017) was conducted. Combination therapy (beta-lactam plus aminoglycoside) was compared to beta-lactam monotherapy. The primary endpoint was the case fatality rate, assessed at 7 and 30 days from BSI onset. Secondary endpoints were nephrotoxicity and persistent BSI. Propensity score (PS) matching was performed. Among 542 GNB BSI episodes, 304 (56%) were initially treated with combination therapy, with cefepime plus amikacin being most common (158/304 [52%]). Overall, Escherichia coli (273/304 [50.4%]) was the main etiological agent, followed by Pseudomonas aeruginosa, which predominated in the combination group (76/304 [25%] versus 28/238 [11.8%]; P < 0.001). Multidrug resistance rates were similar between groups (83/294 [28.2%] versus 63/233 [27%]; P = 0.95). In the multivariate analysis, combination therapy was associated with a lower 7-day case fatality rate (odds ratio [OR], 0.37; 95% CI, 0.14 to 0.91; P = 0.035) with a tendency toward lower mortality at 30 days (OR, 0.56; 95% CI, 0.29 to 1.08; P = 0.084). After PS matching, these differences remained for the 7-day case fatality rate (OR, 0.33; 95% CI, 0.13 to 0.82; P = 0.017). In addition, aminoglycoside use was not significantly associated with renal function impairment (OR, 1.12; 95% CI, 0.26 to 4.87; P = 0.9). The addition of an aminoglycoside to the initial empirical therapy regimen for febrile neutropenic hematological patients should be considered.

引用

页数：10

共 31 条

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