Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to <i>Enterobacter</i>, <i>Serratia</i>, and <i>Citrobacter</i> Species
<b>Objectives:</b> There is debate on whether the use of third-generation cephalosporins (3GC) increases the risk of clinical failure in bloodstream infections (BSIs) caused by chromosomally-mediated AmpC-producing Enterobacterales (CAE). This study evaluates the impact of definitive 3GC...
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2020-05-01
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| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/9/5/254 |
| _version_ | 1797567998664376320 |
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| author | Caroline Derrick P. Brandon Bookstaver Zhiqiang K. Lu Christopher M. Bland S. Travis King Kayla R. Stover Kathey Rumley Shawn H. MacVane Jenna Swindler Scott Kincaid Trisha Branan David Cluck Benjamin Britt Kelly E. Pillinger Bruce M. Jones Virginia Fleming V. Paul DiMondi Sandy Estrada Brad Crane Brian Odle Majdi N. Al-Hasan Julie Ann Justo |
| author_facet | Caroline Derrick P. Brandon Bookstaver Zhiqiang K. Lu Christopher M. Bland S. Travis King Kayla R. Stover Kathey Rumley Shawn H. MacVane Jenna Swindler Scott Kincaid Trisha Branan David Cluck Benjamin Britt Kelly E. Pillinger Bruce M. Jones Virginia Fleming V. Paul DiMondi Sandy Estrada Brad Crane Brian Odle Majdi N. Al-Hasan Julie Ann Justo |
| author_sort | Caroline Derrick |
| collection | DOAJ |
| description | <b>Objectives:</b> There is debate on whether the use of third-generation cephalosporins (3GC) increases the risk of clinical failure in bloodstream infections (BSIs) caused by chromosomally-mediated AmpC-producing Enterobacterales (CAE). This study evaluates the impact of definitive 3GC therapy versus other antibiotics on clinical outcomes in BSIs due to <i>Enterobacter</i>, <i>Serratia</i>, or <i>Citrobacter</i> species. <b>Methods:</b> This multicenter, retrospective cohort study evaluated adult hospitalized patients with BSIs secondary to <i>Enterobacter</i>, <i>Serratia</i>, or <i>Citrobacter</i> species from 1 January 2006 to 1 September 2014. Definitive 3GC therapy was compared to definitive therapy with other non-3GC antibiotics. Multivariable Cox proportional hazards regression evaluated the impact of definitive 3GC on overall treatment failure (OTF) as a composite of in-hospital mortality, 30-day hospital readmission, or 90-day reinfection. <b>Results:</b> A total of 381 patients from 18 institutions in the southeastern United States were enrolled. Common sources of BSIs were the urinary tract and central venous catheters (78 (20.5%) patients each). Definitive 3GC therapy was utilized in 65 (17.1%) patients. OTF occurred in 22/65 patients (33.9%) in the definitive 3GC group vs. 94/316 (29.8%) in the non-3GC group (<i>p</i> = 0.51). Individual components of OTF were comparable between groups. Risk of OTF was comparable with definitive 3GC therapy vs. definitive non-3GC therapy (aHR 0.93, 95% CI 0.51–1.72) in multivariable Cox proportional hazards regression analysis. <b>Conclusions:</b> These outcomes suggest definitive 3GC therapy does not significantly alter the risk of poor clinical outcomes in the treatment of BSIs secondary to <i>Enterobacter, Serratia</i>, or <i>Citrobacter</i> species compared to other antimicrobial agents. |
| first_indexed | 2024-03-10T19:50:08Z |
| format | Article |
| id | doaj.art-f9f3f6fd996d4836b2e3f9a7e854a568 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T19:50:08Z |
| publishDate | 2020-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-f9f3f6fd996d4836b2e3f9a7e854a5682023-11-20T00:29:30ZengMDPI AGAntibiotics2079-63822020-05-019525410.3390/antibiotics9050254Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to <i>Enterobacter</i>, <i>Serratia</i>, and <i>Citrobacter</i> SpeciesCaroline Derrick0P. Brandon Bookstaver1Zhiqiang K. Lu2Christopher M. Bland3S. Travis King4Kayla R. Stover5Kathey Rumley6Shawn H. MacVane7Jenna Swindler8Scott Kincaid9Trisha Branan10David Cluck11Benjamin Britt12Kelly E. Pillinger13Bruce M. Jones14Virginia Fleming15V. Paul DiMondi16Sandy Estrada17Brad Crane18Brian Odle19Majdi N. Al-Hasan20Julie Ann Justo21Department of Medicine, University of South Carolina School of Medicine Columbia, SC 29203, USADepartment of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USADepartment of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USADepartment of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Savannah, GA 31324, USADepartment of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS 39216, USADepartment of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS 39216, USAVidant Medical Center, Greenville, NC 27835, USADepartment of Pharmacy, Medical University of South Carolina, Charleston, SC 29425, USAMcLeod Regional Medical Center, Florence, SC 29506, USAUniversity of Kentucky Healthcare, Lexington, KY 40536, USACollege of Pharmacy, University of Georgia, Athens, GA 30602, USADepartment of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USALexington Medical Center, West Columbia, SC 29169, USACarolinas HealthCare System, Charlotte, NC 28203, USASt. Joseph’s/Candler Health System, Savannah, GA 31405, USACollege of Pharmacy, University of Georgia, Athens, GA 30602, USADepartment of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC 27506, USALee Health, Fort Myers, FL 33901, USABlount Memorial Hospital, Maryville, TN 37804, USADepartment of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USADepartment of Medicine, University of South Carolina School of Medicine Columbia, SC 29203, USADepartment of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA<b>Objectives:</b> There is debate on whether the use of third-generation cephalosporins (3GC) increases the risk of clinical failure in bloodstream infections (BSIs) caused by chromosomally-mediated AmpC-producing Enterobacterales (CAE). This study evaluates the impact of definitive 3GC therapy versus other antibiotics on clinical outcomes in BSIs due to <i>Enterobacter</i>, <i>Serratia</i>, or <i>Citrobacter</i> species. <b>Methods:</b> This multicenter, retrospective cohort study evaluated adult hospitalized patients with BSIs secondary to <i>Enterobacter</i>, <i>Serratia</i>, or <i>Citrobacter</i> species from 1 January 2006 to 1 September 2014. Definitive 3GC therapy was compared to definitive therapy with other non-3GC antibiotics. Multivariable Cox proportional hazards regression evaluated the impact of definitive 3GC on overall treatment failure (OTF) as a composite of in-hospital mortality, 30-day hospital readmission, or 90-day reinfection. <b>Results:</b> A total of 381 patients from 18 institutions in the southeastern United States were enrolled. Common sources of BSIs were the urinary tract and central venous catheters (78 (20.5%) patients each). Definitive 3GC therapy was utilized in 65 (17.1%) patients. OTF occurred in 22/65 patients (33.9%) in the definitive 3GC group vs. 94/316 (29.8%) in the non-3GC group (<i>p</i> = 0.51). Individual components of OTF were comparable between groups. Risk of OTF was comparable with definitive 3GC therapy vs. definitive non-3GC therapy (aHR 0.93, 95% CI 0.51–1.72) in multivariable Cox proportional hazards regression analysis. <b>Conclusions:</b> These outcomes suggest definitive 3GC therapy does not significantly alter the risk of poor clinical outcomes in the treatment of BSIs secondary to <i>Enterobacter, Serratia</i>, or <i>Citrobacter</i> species compared to other antimicrobial agents.https://www.mdpi.com/2079-6382/9/5/254bacteremiacephalosporinssepsisbeta-lactamasesAmpCcarbapenems |
| spellingShingle | Caroline Derrick P. Brandon Bookstaver Zhiqiang K. Lu Christopher M. Bland S. Travis King Kayla R. Stover Kathey Rumley Shawn H. MacVane Jenna Swindler Scott Kincaid Trisha Branan David Cluck Benjamin Britt Kelly E. Pillinger Bruce M. Jones Virginia Fleming V. Paul DiMondi Sandy Estrada Brad Crane Brian Odle Majdi N. Al-Hasan Julie Ann Justo Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to <i>Enterobacter</i>, <i>Serratia</i>, and <i>Citrobacter</i> Species Antibiotics bacteremia cephalosporins sepsis beta-lactamases AmpC carbapenems |
| title | Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to <i>Enterobacter</i>, <i>Serratia</i>, and <i>Citrobacter</i> Species |
| title_full | Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to <i>Enterobacter</i>, <i>Serratia</i>, and <i>Citrobacter</i> Species |
| title_fullStr | Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to <i>Enterobacter</i>, <i>Serratia</i>, and <i>Citrobacter</i> Species |
| title_full_unstemmed | Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to <i>Enterobacter</i>, <i>Serratia</i>, and <i>Citrobacter</i> Species |
| title_short | Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to <i>Enterobacter</i>, <i>Serratia</i>, and <i>Citrobacter</i> Species |
| title_sort | multicenter observational cohort study evaluating third generation cephalosporin therapy for bloodstream infections secondary to i enterobacter i i serratia i and i citrobacter i species |
| topic | bacteremia cephalosporins sepsis beta-lactamases AmpC carbapenems |
| url | https://www.mdpi.com/2079-6382/9/5/254 |
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