PDF(Pubmed)
Abstract：
The recommended therapy for severe infections caused by AmpC-inducible Enterobacterales (AmpC-E) typically involves cefepime or carbapenems. In an era of emerging resistance to these antimicrobials, we aim to assess the impact of third-generation cephalosporins (3GCs) vs. alternative antibiotics on clinical outcomes in bloodstream infections (BSIs) due to AmpC-E. We retrospectively included hospitalized adult patients with BSIs caused by 3GC-susceptible AmpC-E between 2012 and 2022, comparing the outcomes of 3GC and non-3GC definitive therapies. The primary outcome was overall treatment failure (OTF), encompassing 90-day all-cause mortality, 90-day reinfection, and 90-day readmission. Secondary outcomes comprised components of the OTF, in-hospital all-cause mortality, and length-of-stay. Within a total cohort of 353 patients, OTF occurred in 46.5% and 41.5% in the 3GC- and non-3GC-therapy groups, respectively (p = 0.36). The 3GC-therapy group exhibited a longer length-of-stay (38 vs. 21 days, p = 0.0003) and higher in-hospital mortality (23.3% vs. 13.4%, p = 0.019). However, the 90-day mortality, 90-day reinfection, and 90-day readmission were comparable between the therapy groups. Subgroup analyses involving high-risk AmpC-E and 3GC vs. standard-of-care yielded similar conclusions. Overall, our findings suggest that 3GC definitive therapy may not result in poorer clinical outcomes for the treatment of BSIs caused by AmpC-E.
摘要：
由AmpC诱导的肠杆菌（AmpC-E）引起的严重感染的推荐治疗通常涉及头孢吡肟或碳青霉烯类。在对这些抗菌药物产生耐药性的时代，我们的目的是评估第三代头孢菌素(3GCs)与替代抗生素对AmpC-E所致血流感染（BSIs）临床结局的影响我们回顾性纳入2012年至2022年间3GC易感AmpC-E引起的BSI住院成年患者，比较3GC和非3GC确定性治疗的结果。主要结果是总体治疗失败（OTF），包括90天全因死亡率，90天再感染,90天的重新接纳。次要结果包括OTF的组成部分，住院全因死亡率，和停留时间。在总共353名患者中，在3GC和非3GC治疗组中，OTF发生率分别为46.5％和41.5％，分别(p=0.36)。3GC治疗组表现出更长的住院时间（38vs.21天,p=0.0003）和更高的住院死亡率（23.3%与13.4%,p=0.019)。然而,90天死亡率，90天再感染,治疗组之间的再入院和90天的再入院具有可比性.涉及高风险AmpC-E和3GC的亚组分析与标准护理得出了类似的结论。总的来说,我们的发现表明，3GC确定性治疗可能不会导致AmpC-E引起的BSI治疗的临床效果较差。
