Impact of De-escalation on Prognosis of Patients With Bacteremia due to Enterobacteriaceae: A Post Hoc Analysis From a Multicenter Prospective Cohort

被引:20
作者
Palacios-Baena, Zaira R. [1 ,2 ,3 ]
Delgado-Valverde, Mercedes [1 ,2 ,3 ]
Valiente Mendez, Adoracion [1 ,2 ,3 ]
Almirante, Benito [4 ]
Gomez-Zorrilla, Silvia [5 ]
Borrell, Nuria [6 ]
Corzo, Juan E. [7 ]
Gurgui, Mercedes [8 ]
de la Calle, Cristina [9 ]
Garcia-Alvarez, Lara [10 ]
Ramos, Lucia [11 ]
Gozalo, Monica [12 ]
Isabel Morosini, Maria [13 ]
Molina, Jose [14 ,15 ]
Causse, Manuel [16 ]
Pascual, Alvaro [1 ,2 ,3 ]
Rodriguez-Bano, Jesus [1 ,2 ,3 ]
de Cueto, M. [17 ]
Planes Reig, A. M. [18 ]
Tubau Quintano, F. [19 ]
Pena, C. [20 ]
Galan Otalora, M. E. [21 ]
Ruiz de Alegria, C. [22 ]
Canton, R. [23 ,24 ]
Lepe, J. A. [25 ]
Cisneros, J. M. [25 ]
Torre-Cisneros, J. [26 ]
Lara, R. [26 ]
机构
[1] Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol Me, Dept Med, Seville, Spain
[2] Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol Me, Dept Microbiol, Seville, Spain
[3] Inst Biomed Sevilla, Seville, Spain
[4] Hosp Univ Vall dHebron, Serv Malalties Infecciosas, Barcelona, Spain
[5] Hosp Bellvitge Princeps Espanya, Serv Malalties Infecciosas, Barcelona, Spain
[6] Hosp Univ Son Espases, Serv Microbiol, Palma de Mallorca, Islas Baleares, Spain
[7] Hosp Univ Virgen Valme, Unidad Clin Enfermedades Infecciosas & Microbiol, Seville, Spain
[8] Hosp Santa Creu & Sant Pau, Unitat Malaties Infeccioses, Barcelona, Spain
[9] Hosp Clin Barcelona, Serv Malaties Infeccioses, Barcelona, Spain
[10] Hosp San Pedro, Ctr Invest Biomed La Rioja, Dept Enfermedades Infecciosas, Logrono, Spain
[11] Hosp Univ A Coruna, Serv Microbiol, La Coruna, Spain
[12] Hosp Marques Valdecilla, Inst Invest Sanitaria Valdecilla, Serv Microbiol, Santander, Spain
[13] Hosp Ramon & Cajal, Serv Microbiol, Madrid, Spain
[14] Univ Seville, Hosp Univ Virgen Rocio, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain
[15] Inst Biomed Sevilla, Seville, Spain
[16] Univ Cordoba, Inst Maimonides Invest Clin, Hosp Univ Reina Sofia, Unidad Gest Clin Microbiol, Cordoba, Spain
[17] Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol &, Avda Dr Fedriani 3, Seville 41009, Spain
[18] Hosp Univ Vall dHebron, Dept Microbiol, Barcelona, Spain
[19] Hosp Univ Bellvitge, Inst Invest Biomed Bellvitge, Serv Microbiol, Barcelona, Spain
[20] Hosp Univ Bellvitge IDIBELL, Serv Enfermedades Infecciosas, Barcelona, Spain
[21] Hosp Santa Creu & Sant Pau, Barcelona, Spain
[22] Hosp Univ Marques Valdecilla, Serv Microbiol, Santander, Spain
[23] Hosp Univ Ramon & Cajal, Serv Microbiol, Madrid, Spain
[24] Inst Ramon & Cajal Invest Sanitaria, Madrid, Spain
[25] Hosp Virgen Rocio, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain
[26] Univ Cordoba, Inst Maimonides Invest Clin, Hosp Univ Reina Sofia, Unidad Clin Enfermedades infecciosas, Cordoba, Spain
关键词
de-escalation; streamlining; Enterobacteriaceae; bloodstream infections; mortality; ORGAN FAILURE; INFECTIONS; GUIDELINES; EPIDEMIOLOGY; SOCIETY; SEPSIS;
D O I
10.1093/cid/ciy1032
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate predictors of de-escalation and its impact on the outcome of patients with bloodstream infection due to Enterobacteriaceae (BSI-E). Methods. A post hoc analysis was performed on a prospective, multicenter cohort of patients with BSI-E initially treated with ertapenem or antipseudomonal beta-lactams. Logistic regression was used to analyze factors associated with early de-escalation (EDE) and Cox regression for the impact of EDE and late de-escalation (LDE) on 30-day all-cause mortality. A propensity score (PS) for EDE vs no de-escalation (NDE) was calculated. Failure at end of treatment and length of hospital stay were also analyzed. Results. Overall, 516 patients were included. EDE was performed in 241 patients (46%), LDE in 95 (18%), and NDE in 180 (35%). Variables independently associated with a lower probability of EDE were multidrug-resistant isolates (odds ratio [OR], 0.50 [95% confidence interval {CI},.30-.83]) and nosocomial infection empirically treated with imipenem or meropenem (OR, 0.35 [95% CI,.14-.87]). After controlling for confounders, EDE was not associated with increased risk of mortality; hazard ratios (HR) (95% CIs) were as follows: general model, 0.58 (.25-1.31); model with PS, 0.69 (.29-1.65); and PS-based matched pairs, 0.98 (.76-1.26). LDE was not associated with mortality. De-escalation was not associated with clinical failure or length of hospital stay. Conclusions. De-escalation in patients with monomicrobial bacteremia due to Enterobacteriaceae was not associated with a detrimental impact on clinical outcome.
引用
收藏
页码:956 / 962
页数:7
相关论文
共 20 条
[1]   High-temperature thermoelectric transport at small scales: Thermal generation, transport and recombination of minority carriers [J].
Bakan, Gokhan ;
Khan, Niaz ;
Silva, Helena ;
Gokirmak, Ali .
SCIENTIFIC REPORTS, 2013, 3
[2]  
Barlam TF, 2016, CLIN INFECT DIS, V62, pE51, DOI 10.1093/cid/ciw118
[3]   DEFINITIONS FOR SEPSIS AND ORGAN FAILURE AND GUIDELINES FOR THE USE OF INNOVATIVE THERAPIES IN SEPSIS [J].
BONE, RC ;
BALK, RA ;
CERRA, FB ;
DELLINGER, RP ;
FEIN, AM ;
KNAUS, WA ;
SCHEIN, RMH ;
SIBBALD, WJ .
CHEST, 1992, 101 (06) :1644-1655
[4]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383
[5]   MIC of amoxicillin/clavulanate according to CLSI and EUCAST: discrepancies and clinical impact in patients with bloodstream infections due to Enterobacteriaceae [J].
Delgado-Valverde, Mercedes ;
Valiente-Mendez, Adoracion ;
Torres, Eva ;
Almirante, Benito ;
Gomez-Zorrilla, Silvia ;
Borrell, Nuria ;
Isabel Aller-Garcia, Ana ;
Gurgui, Mercedes ;
Almela, Manel ;
Sanz, Mercedes ;
Bou, German ;
Martinez-Martinez, Luis ;
Canton, Rafael ;
Antonio Lepe, Jose ;
Causse, Manuel ;
Gutierrez-Gutierrez, Belen ;
Pascual, Alvaro ;
Rodriguez-Bano, Jesus .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2017, 72 (05) :1478-1487
[6]   Impact of the MIC of piperacillin/tazobactam on the outcome for patients with bacteraemia due to Enterobacteriaceae: the Bacteraemia-MIC project [J].
Delgado-Valverde, Mercedes ;
Torres, Eva ;
Valiente-Mendez, Adoracion ;
Almirante, Benito ;
Gomez-Zorrilla, Silvia ;
Borrell, Nuria ;
Corzo, Juan E. ;
Gurgui, Mercedes ;
Almela, Manuel ;
Garcia-Alvarez, Lara ;
Cruz Fontecoba-Sanchez, Maria ;
Martinez-Martinez, Luis ;
Canton, Rafael ;
Praena, Julia ;
Causse, Manuel ;
Gutierrez-Gutierrez, Belen ;
Roberts, Jason A. ;
Farkas, Andras ;
Pascual, Alvaro ;
Rodriguez-Bano, Jesus .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2016, 71 (02) :521-530
[7]   How should we best treat patients with bloodstream infections? [J].
Eduardo Lopez-Cortes, Luis ;
de Cueto, Marina ;
Rodriguez-Bano, Jesus .
FUTURE MICROBIOLOGY, 2017, 12 (11) :927-930
[8]   Targeted simplification versus antipseudomonal broad-spectrum beta-lactams in patients with bloodstream infections due to Enterobacteriaceae (SIMPLIFY): a study protocol for a multicentre, open-label, phase III randomised, controlled, non-inferiority clinical trial [J].
Eduardo Lopez-Cortes, Luis ;
Rosso-Fernandez, Clara ;
Nunez-Nunez, Maria ;
Lavin-Alconero, Lucia ;
Bravo-Ferrer, Jose ;
Barriga, Angel ;
Delgado, Mercedes ;
Lupion, Carmen ;
Retamar, Pilar ;
Rodriguez-bano, Jesus .
BMJ OPEN, 2017, 7 (06)
[9]  
[EUCAST] The European Committee on Antimicrobial Susceptibility Testing, 2015, BREAKP TABL INT MICS
[10]   Antibiotic de-escalation in the ICU: how is it best done? [J].
Garnacho-Montero, Jose ;
Escoresca-Ortega, Ana ;
Fernandez-Delgado, Esperanza .
CURRENT OPINION IN INFECTIOUS DISEASES, 2015, 28 (02) :193-198