Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections

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Caroline Derrick1, P Brandon Bookstaver2,3, Zhiqiang K Lu2

  • 1Department of Medicine, University of South Carolina School of Medicine Columbia, SC 29203, USA.

Antibiotics (Basel, Switzerland)
|May 20, 2020
PubMed
Abstract

Insights

Third-generation cephalosporins (3GC) did not increase clinical failure risk for bloodstream infections (BSIs) caused by specific Enterobacterales. This study found 3GC therapy comparable to other antibiotics for treating these BSIs.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Antimicrobial Stewardship

Background:

  • Debate exists regarding third-generation cephalosporin (3GC) use and clinical failure in bloodstream infections (BSIs) caused by AmpC-producing Enterobacterales (CAE).
  • Accurate risk assessment is crucial for optimizing antibiotic selection in BSIs.

Purpose of the Study:

  • To evaluate the impact of definitive 3GC therapy versus other antibiotics on clinical outcomes in BSIs.
  • To compare clinical failure rates in patients with BSIs caused by Enterobacter, Serratia, or Citrobacter species treated with 3GC versus non-3GC agents.

Main Methods:

  • Multicenter, retrospective cohort study of adult hospitalized patients with BSIs.
  • Comparison of definitive 3GC therapy versus other non-3GC antibiotics.
  • Multivariable Cox proportional hazards regression analysis to assess overall treatment failure (OTF).

Main Results:

  • 381 patients with BSIs from Enterobacter, Serratia, or Citrobacter species were analyzed.
  • Overall treatment failure (OTF) rates were similar: 33.9% for 3GC vs. 29.8% for non-3GC (p=0.51).
  • Adjusted hazard ratio for OTF was 0.93 (95% CI 0.51-1.72) for 3GC therapy.

Conclusions:

  • Definitive 3GC therapy does not significantly increase the risk of poor clinical outcomes in BSIs caused by Enterobacter, Serratia, or Citrobacter species.
  • 3GC therapy is a viable option comparable to other antimicrobial agents for these specific BSIs.
Keywords:
AmpCbacteremiabeta-lactamasescarbapenemscephalosporinssepsis

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