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Abstract：
BACKGROUND: Bloodstream infections (BSI) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) are associated with high mortality with limited treatment. The aim of this study is to compare effectiveness and safety of colistin-based versus cefiderocol-based therapies for CRAB-BSI.
METHODS: This is a retrospective observational study enrolling patients with monomicrobial CRAB-BSIs treated with colistin or cefiderocol from 1 January 2020, to 31 December 2022. The 30-day all-cause mortality rate was the primary outcome. A Cox regression analysis was performed to identify factors independently associated with mortality. A propensity score analysis using inverse probability of treatment weighting (IPTW) was also performed.
RESULTS: Overall 118 patients were enrolled, 75 (63%) and 43 (37%) treated with colistin- and cefiderocol-based regimens. The median (q1-q3) age was 70 (62-79) years; 70 (59%) patients were men. The 30-day all-cause mortality was 52%, significantly lower in the cefiderocol group (40% vs 59%, p = 0.045). By performing a Cox regression model, age (aHR = 1.03, 95% CI 1.00-1.05), septic shock (aHR = 1.93, 95% CI 1.05-3.53), and delayed targeted therapy (aHR = 2.42, 95% CI 1.11-5.25) were independent predictors of mortality, while cefiderocol-based therapy was protective (aHR = 0.49, 95% CI 0.25-0.93). The IPTW-adjusted Cox analysis confirmed the protective effect of cefiderocol (aHR = 0.53, 95% CI 0.27-0.98).
CONCLUSIONS: Cefiderocol may be a valuable treatment option for CRAB-BSI, especially in the current context of limited treatment options.
METHODS: This is a retrospective observational study enrolling patients with monomicrobial CRAB-BSIs treated with colistin or cefiderocol from 1 January 2020, to 31 December 2022. The 30-day all-cause mortality rate was the primary outcome. A Cox regression analysis was performed to identify factors independently associated with mortality. A propensity score analysis using inverse probability of treatment weighting (IPTW) was also performed.
RESULTS: Overall 118 patients were enrolled, 75 (63%) and 43 (37%) treated with colistin- and cefiderocol-based regimens. The median (q1-q3) age was 70 (62-79) years; 70 (59%) patients were men. The 30-day all-cause mortality was 52%, significantly lower in the cefiderocol group (40% vs 59%, p = 0.045). By performing a Cox regression model, age (aHR = 1.03, 95% CI 1.00-1.05), septic shock (aHR = 1.93, 95% CI 1.05-3.53), and delayed targeted therapy (aHR = 2.42, 95% CI 1.11-5.25) were independent predictors of mortality, while cefiderocol-based therapy was protective (aHR = 0.49, 95% CI 0.25-0.93). The IPTW-adjusted Cox analysis confirmed the protective effect of cefiderocol (aHR = 0.53, 95% CI 0.27-0.98).
CONCLUSIONS: Cefiderocol may be a valuable treatment option for CRAB-BSI, especially in the current context of limited treatment options.
摘要：
背景：耐碳青霉烯鲍曼不动杆菌（CRAB）引起的血流感染（BSI）与治疗有限的高死亡率相关。这项研究的目的是比较基于粘菌素与基于头孢地洛的治疗对CRAB-BSI的有效性和安全性。
方法：这是一项回顾性观察性研究，纳入2020年1月1日至2022年12月31日接受粘菌素或头孢地洛治疗的单抗微生物CRAB-BSIs患者。30天全因死亡率是主要结果。进行Cox回归分析以确定与死亡率独立相关的因素。还进行了使用治疗加权逆概率(IPTW)的倾向评分分析。
结果：共纳入118例患者，75例（63％）和43例（37％）接受基于科力菌素和头孢地洛的方案治疗。中位（q1-q3）年龄为70（62-79）岁；70（59％）患者为男性。30天全因死亡率为52%,头孢地洛组显著较低(40%vs59%，p=0.045)。通过执行Cox回归模型，年龄（AHR=1.03，95%CI1.00-1.05），感染性休克（aHR=1.93，95%CI1.05-3.53），延迟靶向治疗(aHR=2.42,95%CI1.11-5.25)是死亡率的独立预测因子,而以头孢地洛为基础的治疗是保护性的(aHR=0.49,95%CI0.25-0.93)。IPTW调整的Cox分析证实了头孢地洛的保护作用(aHR=0.53，95%CI0.27-0.98)。
结论：头孢地洛可能是CRAB-BSI的一种有价值的治疗选择，特别是在目前治疗方案有限的情况下。
方法：这是一项回顾性观察性研究，纳入2020年1月1日至2022年12月31日接受粘菌素或头孢地洛治疗的单抗微生物CRAB-BSIs患者。30天全因死亡率是主要结果。进行Cox回归分析以确定与死亡率独立相关的因素。还进行了使用治疗加权逆概率(IPTW)的倾向评分分析。
结果：共纳入118例患者，75例（63％）和43例（37％）接受基于科力菌素和头孢地洛的方案治疗。中位（q1-q3）年龄为70（62-79）岁；70（59％）患者为男性。30天全因死亡率为52%,头孢地洛组显著较低(40%vs59%，p=0.045)。通过执行Cox回归模型，年龄（AHR=1.03，95%CI1.00-1.05），感染性休克（aHR=1.93，95%CI1.05-3.53），延迟靶向治疗(aHR=2.42,95%CI1.11-5.25)是死亡率的独立预测因子,而以头孢地洛为基础的治疗是保护性的(aHR=0.49,95%CI0.25-0.93)。IPTW调整的Cox分析证实了头孢地洛的保护作用(aHR=0.53，95%CI0.27-0.98)。
结论：头孢地洛可能是CRAB-BSI的一种有价值的治疗选择，特别是在目前治疗方案有限的情况下。
