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Abstract：
OBJECTIVE: There is debate on whether the use of third-generation cephalosporins (3GC) increases the risk of clinical failure in bloodstream infections (BSIs) caused by chromosomally-mediated AmpC-producing Enterobacterales (CAE). This study evaluates the impact of definitive 3GC therapy versus other antibiotics on clinical outcomes in BSIs due to Enterobacter, Serratia, or Citrobacter species.
METHODS: This multicenter, retrospective cohort study evaluated adult hospitalized patients with BSIs secondary to Enterobacter, Serratia, or Citrobacter species from 1 January 2006 to 1 September 2014. Definitive 3GC therapy was compared to definitive therapy with other non-3GC antibiotics. Multivariable Cox proportional hazards regression evaluated the impact of definitive 3GC on overall treatment failure (OTF) as a composite of in-hospital mortality, 30-day hospital readmission, or 90-day reinfection.
RESULTS: A total of 381 patients from 18 institutions in the southeastern United States were enrolled. Common sources of BSIs were the urinary tract and central venous catheters (78 (20.5%) patients each). Definitive 3GC therapy was utilized in 65 (17.1%) patients. OTF occurred in 22/65 patients (33.9%) in the definitive 3GC group vs. 94/316 (29.8%) in the non-3GC group (p = 0.51). Individual components of OTF were comparable between groups. Risk of OTF was comparable with definitive 3GC therapy vs. definitive non-3GC therapy (aHR 0.93, 95% CI 0.51-1.72) in multivariable Cox proportional hazards regression analysis.
CONCLUSIONS: These outcomes suggest definitive 3GC therapy does not significantly alter the risk of poor clinical outcomes in the treatment of BSIs secondary to Enterobacter, Serratia, or Citrobacter species compared to other antimicrobial agents.
METHODS: This multicenter, retrospective cohort study evaluated adult hospitalized patients with BSIs secondary to Enterobacter, Serratia, or Citrobacter species from 1 January 2006 to 1 September 2014. Definitive 3GC therapy was compared to definitive therapy with other non-3GC antibiotics. Multivariable Cox proportional hazards regression evaluated the impact of definitive 3GC on overall treatment failure (OTF) as a composite of in-hospital mortality, 30-day hospital readmission, or 90-day reinfection.
RESULTS: A total of 381 patients from 18 institutions in the southeastern United States were enrolled. Common sources of BSIs were the urinary tract and central venous catheters (78 (20.5%) patients each). Definitive 3GC therapy was utilized in 65 (17.1%) patients. OTF occurred in 22/65 patients (33.9%) in the definitive 3GC group vs. 94/316 (29.8%) in the non-3GC group (p = 0.51). Individual components of OTF were comparable between groups. Risk of OTF was comparable with definitive 3GC therapy vs. definitive non-3GC therapy (aHR 0.93, 95% CI 0.51-1.72) in multivariable Cox proportional hazards regression analysis.
CONCLUSIONS: These outcomes suggest definitive 3GC therapy does not significantly alter the risk of poor clinical outcomes in the treatment of BSIs secondary to Enterobacter, Serratia, or Citrobacter species compared to other antimicrobial agents.
摘要：
目的：关于使用第三代头孢菌素（3GC）是否会增加由染色体介导的产AmpC肠杆菌（CAE）引起的血流感染（BSIs）临床失败的风险存在争议。本研究评估了明确的3GC治疗与其他抗生素对肠杆菌引起的BSI临床结果的影响，Serratia,或柠檬酸杆菌属。
方法：这个多中心，回顾性队列研究评估了肠杆菌继发BSI的成年住院患者，Serratia,或柠檬酸杆菌属，从2006年1月1日至2014年9月1日。将明确的3GC治疗与其他非3GC抗生素的明确治疗进行比较。多变量Cox比例风险回归评估了确定的3GC对整体治疗失败（OTF）的影响，作为院内死亡率的复合，30天再次住院,或90天再感染。
结果：共纳入来自美国东南部18个机构的381名患者。BSI的常见来源是泌尿道和中心静脉导管（各78例（20.5％）患者）。65例（17.1%）患者采用了明确的3GC治疗。OTF发生在确定的3GC组中的22/65患者（33.9%）与非3GC组94/316(29.8%)(p=0.51)。OTF的各个成分在组间具有可比性。OTF的风险与确定性3GC疗法相比多变量Cox比例风险回归分析中确定的非3GC治疗（aHR0.93，95％CI0.51-1.72）。
结论：这些结果提示明确的3GC治疗不会显著改变肠杆菌继发BSI的临床预后不良的风险，Serratia,或柠檬酸杆菌属与其他抗菌剂相比。
方法：这个多中心，回顾性队列研究评估了肠杆菌继发BSI的成年住院患者，Serratia,或柠檬酸杆菌属，从2006年1月1日至2014年9月1日。将明确的3GC治疗与其他非3GC抗生素的明确治疗进行比较。多变量Cox比例风险回归评估了确定的3GC对整体治疗失败（OTF）的影响，作为院内死亡率的复合，30天再次住院,或90天再感染。
结果：共纳入来自美国东南部18个机构的381名患者。BSI的常见来源是泌尿道和中心静脉导管（各78例（20.5％）患者）。65例（17.1%）患者采用了明确的3GC治疗。OTF发生在确定的3GC组中的22/65患者（33.9%）与非3GC组94/316(29.8%)(p=0.51)。OTF的各个成分在组间具有可比性。OTF的风险与确定性3GC疗法相比多变量Cox比例风险回归分析中确定的非3GC治疗（aHR0.93，95％CI0.51-1.72）。
结论：这些结果提示明确的3GC治疗不会显著改变肠杆菌继发BSI的临床预后不良的风险，Serratia,或柠檬酸杆菌属与其他抗菌剂相比。
