Impact of De-escalation on Prognosis of Patients With Bacteremia due to Enterobacteriaceae: A Post Hoc Analysis From a Multicenter Prospective Cohort
Por:
Palacios-Baena, ZR, Delgado-Valverde, M, Mendez, AV, Almirante, B, Gomez-Zorrilla, S, Borrell, N, Corzo, JE, Gurgui, M, de la Calle, C, Garcia-Alvarez, L, Ramos, L, Gozalo, M, Morosini, MI, Molina, J, Causse, M, Pascual, A, Rodriguez-Bano, J, de Cueto, M, Reig, AMP, Quintano, FT, Pena, C, Otalora, MEG, de Alegria, CR, Canton, R, Lepe, JA, Cisneros, JM, Torre-Cisneros, J, Lara, R
Publicada:
15 sep 2019
Resumen:
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.
Filiaciones:
Palacios-Baena, ZR:
Inst Biomed Sevilla, Seville, Spain
Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol Me, Dept Microbiol, Seville, Spain
Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol Me, Dept Med, Seville, Spain
Delgado-Valverde, M:
Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol Me, Dept Microbiol, Seville, Spain
Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol Me, Dept Med, Seville, Spain
Inst Biomed Sevilla, Seville, Spain
Mendez, AV:
Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol Me, Dept Microbiol, Seville, Spain
Inst Biomed Sevilla, Seville, Spain
Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol Me, Dept Med, Seville, Spain
Almirante, B:
Hosp Univ Vall dHebron, Serv Malalties Infecciosas, Barcelona, Spain
Gomez-Zorrilla, S:
Hosp Bellvitge Princeps Espanya, Serv Malalties Infecciosas, Barcelona, Spain
Borrell, N:
Hosp Univ Son Espases, Serv Microbiol, Palma de Mallorca, Islas Baleares, Spain
Corzo, JE:
Hosp Univ Virgen Valme, Unidad Clin Enfermedades Infecciosas & Microbiol, Seville, Spain
Gurgui, M:
Hosp Santa Creu & Sant Pau, Unitat Malaties Infeccioses, Barcelona, Spain
de la Calle, C:
Hosp Clin Barcelona, Serv Malaties Infeccioses, Barcelona, Spain
Garcia-Alvarez, L:
Hosp San Pedro, Ctr Invest Biomed La Rioja, Dept Enfermedades Infecciosas, Logrono, Spain
Ramos, L:
Hosp Univ A Coruna, Serv Microbiol, La Coruna, Spain
Gozalo, M:
Hosp Marques Valdecilla, Inst Invest Sanitaria Valdecilla, Serv Microbiol, Santander, Spain
Morosini, MI:
Hosp Ramon & Cajal, Serv Microbiol, Madrid, Spain
Molina, J:
Inst Biomed Sevilla, Seville, Spain
Univ Seville, Hosp Univ Virgen Rocio, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain
Causse, M:
Univ Cordoba, Inst Maimonides Invest Clin, Hosp Univ Reina Sofia, Unidad Gest Clin Microbiol, Cordoba, Spain
Pascual, A:
Inst Biomed Sevilla, Seville, Spain
Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol Me, Dept Microbiol, Seville, Spain
Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol Me, Dept Med, Seville, Spain
Rodriguez-Bano, J:
Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol Me, Dept Microbiol, Seville, Spain
Inst Biomed Sevilla, Seville, Spain
Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol Me, Dept Med, Seville, Spain
de Cueto, M:
Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol &, Avda Dr Fedriani 3, Seville 41009, Spain
Reig, AMP:
Hosp Univ Vall dHebron, Dept Microbiol, Barcelona, Spain
Quintano, FT:
Hosp Univ Bellvitge, Inst Invest Biomed Bellvitge, Serv Microbiol, Barcelona, Spain
Pena, C:
Hosp Univ Bellvitge IDIBELL, Serv Enfermedades Infecciosas, Barcelona, Spain
Otalora, MEG:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
de Alegria, CR:
Hosp Univ Marques Valdecilla, Serv Microbiol, Santander, Spain
Canton, R:
Hosp Univ Ramon & Cajal, Serv Microbiol, Madrid, Spain
Inst Ramon & Cajal Invest Sanitaria, Madrid, Spain
Lepe, JA:
Hosp Virgen Rocio, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain
Cisneros, JM:
Hosp Virgen Rocio, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain
Torre-Cisneros, J:
Univ Cordoba, Inst Maimonides Invest Clin, Hosp Univ Reina Sofia, Unidad Clin Enfermedades infecciosas, Cordoba, Spain
Lara, R:
Univ Cordoba, Inst Maimonides Invest Clin, Hosp Univ Reina Sofia, Unidad Clin Enfermedades infecciosas, Cordoba, Spain
Bronze
|