Clinical Outcomes of Third-Generation Cephalosporin Definitive Therapy for Bloodstream Infections Due to Enterobacterales with Potential AmpC Induction: A Single-Center Retrospective Study
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...
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MDPI AG
2023-09-01
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| Series: | Pathogens |
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| Online Access: | https://www.mdpi.com/2076-0817/12/9/1152 |
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| author | Gilles Vossius Cécile Meex Filip Moerman Marie Thys Marie Ernst Marie-Eve Bourgeois Léa Wagner Thibaut Delahaye Gilles Darcis |
| author_facet | Gilles Vossius Cécile Meex Filip Moerman Marie Thys Marie Ernst Marie-Eve Bourgeois Léa Wagner Thibaut Delahaye Gilles Darcis |
| author_sort | Gilles Vossius |
| collection | DOAJ |
| description | 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 (<i>p</i> = 0.36). The 3GC-therapy group exhibited a longer length-of-stay (38 vs. 21 days, <i>p</i> = 0.0003) and higher in-hospital mortality (23.3% vs. 13.4%, <i>p</i> = 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. |
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| issn | 2076-0817 |
| language | English |
| last_indexed | 2024-03-10T22:18:07Z |
| publishDate | 2023-09-01 |
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| series | Pathogens |
| spelling | doaj.art-1e61ca1d646c4d48a8ef4e7479df0e9c2023-11-19T12:22:48ZengMDPI AGPathogens2076-08172023-09-01129115210.3390/pathogens12091152Clinical Outcomes of Third-Generation Cephalosporin Definitive Therapy for Bloodstream Infections Due to Enterobacterales with Potential AmpC Induction: A Single-Center Retrospective StudyGilles Vossius0Cécile Meex1Filip Moerman2Marie Thys3Marie Ernst4Marie-Eve Bourgeois5Léa Wagner6Thibaut Delahaye7Gilles Darcis8Département des Maladies Infectieuses, Centre Hospitalier Universitaire de Liège, 4000 Liège, BelgiumService de Microbiologie Clinique, Université de Liège, 4000 Liège, BelgiumDépartement des Maladies Infectieuses, Hôpital de la Citadelle, 4000 Liège, BelgiumService des Informations Médico-Économiques, Centre Hospitalier Universitaire de Liège, 4000 Liège, BelgiumBiostatistics and Research Method Center (B-STAT), Centre Hospitalier Universitaire de Liège, 4000 Liège, BelgiumFaculté de Médecine, Université de Liège, 4000 Liège, BelgiumFaculté de Médecine, Université de Liège, 4000 Liège, BelgiumFaculté de Médecine, Université de Liège, 4000 Liège, BelgiumDépartement des Maladies Infectieuses, Centre Hospitalier Universitaire de Liège, 4000 Liège, BelgiumThe 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 (<i>p</i> = 0.36). The 3GC-therapy group exhibited a longer length-of-stay (38 vs. 21 days, <i>p</i> = 0.0003) and higher in-hospital mortality (23.3% vs. 13.4%, <i>p</i> = 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.https://www.mdpi.com/2076-0817/12/9/1152AmpCEnterobacteralesEnterobacteriaceaebeta-lactamasescephalosporinsantimicrobial resistance |
| spellingShingle | Gilles Vossius Cécile Meex Filip Moerman Marie Thys Marie Ernst Marie-Eve Bourgeois Léa Wagner Thibaut Delahaye Gilles Darcis Clinical Outcomes of Third-Generation Cephalosporin Definitive Therapy for Bloodstream Infections Due to Enterobacterales with Potential AmpC Induction: A Single-Center Retrospective Study Pathogens AmpC Enterobacterales Enterobacteriaceae beta-lactamases cephalosporins antimicrobial resistance |
| title | Clinical Outcomes of Third-Generation Cephalosporin Definitive Therapy for Bloodstream Infections Due to Enterobacterales with Potential AmpC Induction: A Single-Center Retrospective Study |
| title_full | Clinical Outcomes of Third-Generation Cephalosporin Definitive Therapy for Bloodstream Infections Due to Enterobacterales with Potential AmpC Induction: A Single-Center Retrospective Study |
| title_fullStr | Clinical Outcomes of Third-Generation Cephalosporin Definitive Therapy for Bloodstream Infections Due to Enterobacterales with Potential AmpC Induction: A Single-Center Retrospective Study |
| title_full_unstemmed | Clinical Outcomes of Third-Generation Cephalosporin Definitive Therapy for Bloodstream Infections Due to Enterobacterales with Potential AmpC Induction: A Single-Center Retrospective Study |
| title_short | Clinical Outcomes of Third-Generation Cephalosporin Definitive Therapy for Bloodstream Infections Due to Enterobacterales with Potential AmpC Induction: A Single-Center Retrospective Study |
| title_sort | clinical outcomes of third generation cephalosporin definitive therapy for bloodstream infections due to enterobacterales with potential ampc induction a single center retrospective study |
| topic | AmpC Enterobacterales Enterobacteriaceae beta-lactamases cephalosporins antimicrobial resistance |
| url | https://www.mdpi.com/2076-0817/12/9/1152 |
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