Related Experiment Video
Updated: Jun 14, 2025
Quadruple-Checkerboard: A Modification of the Three-Dimensional Checkerboard for Studying Drug Combinations
Published on: July 24, 2021
Adverse Events Comparison of Double Beta-Lactam Combinations for Bloodstream Infections: Ampicillin plus Ceftriaxone
Kazuhiro Ishikawa1, Daiki Kobayashi2, Nobuyoshi Mori1
1Department of Infectious Diseases, St. Luke's International University, Tokyo 104-8560, Japan.
Abstract:
In Japan, only ampicillin/cloxacillin (ABPC/MCIPC) is available as an anti-staphylococcal penicillin-based treatment for Staphylococcus aureus bacteremia. However, the incidence of adverse events associated with double beta-lactam administration remains unknown. Therefore, we investigated the adverse events of double beta-lactam administration in patients with bacteremia. Adult patients (≥18 years) with bacteremia treated with ABPC, ABPC + ceftriaxone (CTRX), or ABPC/MCIPC were retrospectively analyzed. The primary outcome of this study was the incidence of adverse events such as acute kidney injury, liver dysfunction, and myelosuppression. Chi-square tests and t-tests were used for bivariate analysis. Propensity score (PS) matching was conducted to adjust for confounding factors. We included 277 ABPC-, 57 ABPC + CTRX-, and 43 ABPC/MCIPC-treated patients. Significant differences were noted in age, number of male patients, proportion of patients with qSOFA score ≥2, incidence of chronic kidney disease, treatment duration, mechanical ventilation use, vasopressor use, and proportion of patients with acute kidney injury (AKI) KDIGO grade ≥2. Further, a significant difference was observed between ABPC and ABPC/MCIPC, with a hazard ratio of 1.83 in AKI. In the PS-matched cohort, AKI incidence associated with ABPC/MCIPC was significantly higher than that associated with ABPC. ABPC + CTRX may be safe, whereas ABPC/MCIPC presents a higher risk of AKI and may not be suitable.
Insights
Ampicillin/cloxacillin (ABPC/MCIPC) for Staphylococcus aureus bacteremia may increase acute kidney injury (AKI) risk compared to ampicillin (ABPC). Ampicillin plus ceftriaxone (ABPC + CTRX) appears safer for treating bacteremia.
Area of Science:
- Infectious Diseases
- Pharmacology
- Nephrology
Background:
- Staphylococcus aureus bacteremia treatment in Japan relies on ampicillin/cloxacillin (ABPC/MCIPC).
- The safety profile, specifically adverse events of double beta-lactam regimens, is not well-established.
- Understanding these risks is crucial for optimizing patient care.
Purpose of the Study:
- To investigate and compare the incidence of adverse events associated with different beta-lactam regimens in patients with bacteremia.
- To evaluate the safety of ampicillin (ABPC), ampicillin plus ceftriaxone (ABPC + CTRX), and ampicillin/cloxacillin (ABPC/MCIPC).
Main Methods:
- Retrospective analysis of adult patients (≥18 years) with bacteremia.
- Treatment groups included ABPC, ABPC + CTRX, and ABPC/MCIPC.
- Primary outcomes: acute kidney injury (AKI), liver dysfunction, myelosuppression. Propensity score matching was used to control for confounding factors.
Main Results:
- A higher incidence of AKI (KDIGO grade ≥2) was observed in the ABPC/MCIPC group compared to the ABPC group (Hazard Ratio: 1.83).
- Propensity score matching confirmed significantly higher AKI incidence with ABPC/MCIPC versus ABPC.
- No significant difference in AKI was noted for ABPC + CTRX compared to ABPC in the matched cohort.
Conclusions:
- Ampicillin/cloxacillin (ABPC/MCIPC) is associated with a significantly higher risk of acute kidney injury in patients with bacteremia.
- Ampicillin plus ceftriaxone (ABPC + CTRX) may be a safer alternative, while ABPC/MCIPC may not be suitable due to increased AKI risk.
More Related Videos
12:03Antimicrobial Synergy Testing by the Inkjet Printer-assisted Automated Checkerboard Array and the Manual Time-kill Method
Published on: April 18, 2019
08:30One-day Workflow Scheme for Bacterial Pathogen Detection and Antimicrobial Resistance Testing from Blood Cultures
Published on: July 9, 2012
