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Abstract：
Objective: Carbapenems are considered treatment of choice for bacteremia caused by potential AmpC-producing bacteria, including Enterobacter spp. We aimed to compare mortality following carbapenem vs. alternative antibiotics for the treatment of Enterobacter spp. bacteremia. Patients and Methods: We conducted a retrospective study in two centers in Israel. We included hospitalized patients with Enterobacter bacteremia treated with third-generation cephalosporins (3GC), piperacillin/tazobactam, quinolones, or carbapenem monotherapy as the main antibiotic in the first week of treatment, between 2010 and 2017. Cefepime was excluded due to nonavailability during study years. The primary outcome was 30-day all-cause mortality. Univariate and multivariate analyses were conducted, introducing the main antibiotic as an independent variable. Results: Two hundred seventy-seven consecutive patients were included in the analyses. Of these, 73 were treated with 3GC, 39 with piperacillin/tazobactam, 104 with quinolones, and 61 with carbapenems. All-cause 30-day mortality was 16% (45 patients). The type of antibiotics was not significantly associated with mortality on univariate or multivariate analyses. With carbapenems as reference, adjusted odds ratios (ORs) for mortality were 0.708, 95% confidence interval (CI) 0.231-2.176 with 3GC; OR 1.172, 95% CI 0.388-3.537 with piperacillin/tazobactam; and OR 0.586, 95% CI 0.229-1.4 with quinolones. The main antibiotic was not associated with repeated growth of Entrobacter spp. in blood cultures or other clinical specimens. Resistance development was observed with 3GC and piperacillin/tazobactam. Conclusions: Carbapenem treatment was not advantageous to alternative antibiotics, including 3GC, among patients with Enterobacter spp. bacteremia in an observational study.
摘要：
目的：碳青霉烯类抗生素被认为是治疗由潜在产生AmpC的细菌引起的菌血症的首选药物，包括肠杆菌。我们的目的是比较碳青霉烯类与用于治疗肠杆菌属的替代抗生素。菌血症.患者和方法：我们在以色列的两个中心进行了一项回顾性研究。我们纳入了接受第三代头孢菌素（3GC）治疗的肠杆菌菌血症住院患者，哌拉西林/他唑巴坦,喹诺酮类药物,或碳青霉烯类单药作为治疗第一周的主要抗生素，2010年至2017年。由于在研究期间无法使用，头孢吡肟被排除在外。主要结果是30天全因死亡率。进行了单变量和多变量分析，引入主要抗生素作为自变量。结果：分析中包括二百七十七名连续患者。其中,用3GC处理73，39与哌拉西林/他唑巴坦，104与喹诺酮类药物，61与碳青霉烯类。全因30天死亡率为16%(45例)。在单变量或多变量分析中，抗生素的类型与死亡率没有显着相关。以碳青霉烯类为参考，3GC的死亡率校正比值比(OR)为0.708,95%置信区间(CI)0.231~2.176;哌拉西林/他唑巴坦的OR为1.172,95%CI0.388~3.537;喹诺酮类药物的OR为0.586,95%CI0.229~1.4.主要抗生素与Entrobacterspp的重复生长无关。血培养物或其他临床标本。用3GC和哌拉西林/他唑巴坦观察到耐药性发展。结论:碳青霉烯类抗生素治疗不利于替代抗生素,包括3GC，在肠杆菌患者中。观察性研究中的菌血症。
