Empirical fluoroquinolones versus broad-spectrum beta-lactams for Gram-negative bloodstream infections in the absence of antimicrobial resistance risk factors
Objectives: Increasing antimicrobial resistance rates limit empirical antimicrobial treatment options for Gram-negative bloodstream infections (GN-BSI). However, antimicrobial resistance may be predicted based on patient-specific risk factors using precision medicine concepts. This retrospective, 1:...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-09-01
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| Series: | Journal of Global Antimicrobial Resistance |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716519303297 |
| _version_ | 1819082463016648704 |
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| author | Majdi N. Al-Hasan Alyssa P. Gould Chelsea Drennan Olivia Hill Julie Ann Justo Joseph Kohn P. Brandon Bookstaver |
| author_facet | Majdi N. Al-Hasan Alyssa P. Gould Chelsea Drennan Olivia Hill Julie Ann Justo Joseph Kohn P. Brandon Bookstaver |
| author_sort | Majdi N. Al-Hasan |
| collection | DOAJ |
| description | Objectives: Increasing antimicrobial resistance rates limit empirical antimicrobial treatment options for Gram-negative bloodstream infections (GN-BSI). However, antimicrobial resistance may be predicted based on patient-specific risk factors using precision medicine concepts. This retrospective, 1:2 matched cohort examined clinical outcomes in hospitalized adults without major risk factors for antimicrobial resistance receiving empirical fluoroquinolones or broad-spectrum beta-lactams (BSBL) for GN-BSI at Prisma Health-Midlands hospitals in Columbia, SC, USA from January 2010 through June 2015. Methods: Multivariable logistic regression was used to examine early treatment failure at 72–96 h from GN-BSI. Cox proportional hazards regression was used to examine 28-day mortality and hospital length of stay (HLOS). Results: Among 74 and 148 patients receiving empirical fluoroquinolones and BSBL for GN-BSI, respectively, median age was 68 years, 159 (72%) were women, and 152 (68%) had a urinary source of infection. Early treatment failure rates were comparable in fluoroquinolone and BSBL groups (27% vs. 30%, respectively, odds ratio 0.82, 95% confidence intervals [CI] 0.43–1.54, P = 0.53), as well as 28-day mortality (8.9% vs. 9.7%, respectively, hazards ratio [HR] 0.74, 95% CI 0.26–1.90, P = 0.54). Median HLOS was 6.1 days in the fluoroquinolone group and 7.1 days in the BSBL group (HR 0.73, 95% CI 0.54–0.99, P = 0.04). Transition from intravenous to oral therapy occurred sooner in the fluoroquinolone group than in the BSBL group (3.0 vs. 4.9 days, P < 0.001). Conclusions: In the absence of antimicrobial resistance risk factors, fluoroquinolones provide an additional empirical treatment option to BSBL for GN-BSI. Shorter HLOS in the fluoroquinolone group may be due to earlier transition from intravenous to oral antimicrobial therapy. |
| first_indexed | 2024-12-21T20:17:04Z |
| format | Article |
| id | doaj.art-0e968f46680642218eddb12d81abc7c9 |
| institution | Directory Open Access Journal |
| issn | 2213-7165 |
| language | English |
| last_indexed | 2024-12-21T20:17:04Z |
| publishDate | 2020-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Global Antimicrobial Resistance |
| spelling | doaj.art-0e968f46680642218eddb12d81abc7c92022-12-21T18:51:35ZengElsevierJournal of Global Antimicrobial Resistance2213-71652020-09-01228793Empirical fluoroquinolones versus broad-spectrum beta-lactams for Gram-negative bloodstream infections in the absence of antimicrobial resistance risk factorsMajdi N. Al-Hasan0Alyssa P. Gould1Chelsea Drennan2Olivia Hill3Julie Ann Justo4Joseph Kohn5P. Brandon Bookstaver6School of Medicine, University of South Carolina, Columbia, SC, USA; Palmetto Health-USC Medical Group, University of South Carolina, Columbia, SC, USA; Corresponding author at: University of South Carolina School of Medicine, 2 Medical Park, Suite 502, Columbia, SC 29203, USA.Novant Health, Charlotte, NC, USACollege of Pharmacy, University of South Carolina, Columbia, SC, USACollege of Pharmacy, University of South Carolina, Columbia, SC, USACollege of Pharmacy, University of South Carolina, Columbia, SC, USA; Prisma Health Richland Hospital, Columbia, SC, USAPrisma Health Richland Hospital, Columbia, SC, USACollege of Pharmacy, University of South Carolina, Columbia, SC, USA; Prisma Health Richland Hospital, Columbia, SC, USAObjectives: Increasing antimicrobial resistance rates limit empirical antimicrobial treatment options for Gram-negative bloodstream infections (GN-BSI). However, antimicrobial resistance may be predicted based on patient-specific risk factors using precision medicine concepts. This retrospective, 1:2 matched cohort examined clinical outcomes in hospitalized adults without major risk factors for antimicrobial resistance receiving empirical fluoroquinolones or broad-spectrum beta-lactams (BSBL) for GN-BSI at Prisma Health-Midlands hospitals in Columbia, SC, USA from January 2010 through June 2015. Methods: Multivariable logistic regression was used to examine early treatment failure at 72–96 h from GN-BSI. Cox proportional hazards regression was used to examine 28-day mortality and hospital length of stay (HLOS). Results: Among 74 and 148 patients receiving empirical fluoroquinolones and BSBL for GN-BSI, respectively, median age was 68 years, 159 (72%) were women, and 152 (68%) had a urinary source of infection. Early treatment failure rates were comparable in fluoroquinolone and BSBL groups (27% vs. 30%, respectively, odds ratio 0.82, 95% confidence intervals [CI] 0.43–1.54, P = 0.53), as well as 28-day mortality (8.9% vs. 9.7%, respectively, hazards ratio [HR] 0.74, 95% CI 0.26–1.90, P = 0.54). Median HLOS was 6.1 days in the fluoroquinolone group and 7.1 days in the BSBL group (HR 0.73, 95% CI 0.54–0.99, P = 0.04). Transition from intravenous to oral therapy occurred sooner in the fluoroquinolone group than in the BSBL group (3.0 vs. 4.9 days, P < 0.001). Conclusions: In the absence of antimicrobial resistance risk factors, fluoroquinolones provide an additional empirical treatment option to BSBL for GN-BSI. Shorter HLOS in the fluoroquinolone group may be due to earlier transition from intravenous to oral antimicrobial therapy.http://www.sciencedirect.com/science/article/pii/S2213716519303297BacteraemiaSepsisEnterobacteriaceaeEscherichia coliPenicillinsCephalosporins |
| spellingShingle | Majdi N. Al-Hasan Alyssa P. Gould Chelsea Drennan Olivia Hill Julie Ann Justo Joseph Kohn P. Brandon Bookstaver Empirical fluoroquinolones versus broad-spectrum beta-lactams for Gram-negative bloodstream infections in the absence of antimicrobial resistance risk factors Journal of Global Antimicrobial Resistance Bacteraemia Sepsis Enterobacteriaceae Escherichia coli Penicillins Cephalosporins |
| title | Empirical fluoroquinolones versus broad-spectrum beta-lactams for Gram-negative bloodstream infections in the absence of antimicrobial resistance risk factors |
| title_full | Empirical fluoroquinolones versus broad-spectrum beta-lactams for Gram-negative bloodstream infections in the absence of antimicrobial resistance risk factors |
| title_fullStr | Empirical fluoroquinolones versus broad-spectrum beta-lactams for Gram-negative bloodstream infections in the absence of antimicrobial resistance risk factors |
| title_full_unstemmed | Empirical fluoroquinolones versus broad-spectrum beta-lactams for Gram-negative bloodstream infections in the absence of antimicrobial resistance risk factors |
| title_short | Empirical fluoroquinolones versus broad-spectrum beta-lactams for Gram-negative bloodstream infections in the absence of antimicrobial resistance risk factors |
| title_sort | empirical fluoroquinolones versus broad spectrum beta lactams for gram negative bloodstream infections in the absence of antimicrobial resistance risk factors |
| topic | Bacteraemia Sepsis Enterobacteriaceae Escherichia coli Penicillins Cephalosporins |
| url | http://www.sciencedirect.com/science/article/pii/S2213716519303297 |
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