Article (Scientific journals)
Clinical Outcomes of Third-Generation Cephalosporin Definitive Therapy for Bloodstream Infections Due to Enterobacterales with Potential AmpC Induction: A Single-Center Retrospective Study.
Vossius, Gilles; Meex, Cécile; Moerman, Filip et al.
2023In Pathogens (Basel, Switzerland), 12 (9), p. 1152
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Keywords :
AmpC; Enterobacterales; Enterobacteriaceae; antimicrobial resistance; beta-lactamases; cephalosporins; Immunology and Allergy; Molecular Biology; Immunology and Microbiology (all); Microbiology (medical); Infectious Diseases; General Immunology and Microbiology
Abstract :
[en] 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 (p = 0.36). The 3GC-therapy group exhibited a longer length-of-stay (38 vs. 21 days, p = 0.0003) and higher in-hospital mortality (23.3% vs. 13.4%, p = 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.
Disciplines :
Immunology & infectious disease
Author, co-author :
Vossius, Gilles;  Département des Maladies Infectieuses, Centre Hospitalier Universitaire de Liège, 4000 Liège, Belgium
Meex, Cécile ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de microbiologie clinique
Moerman, Filip ;  Université de Liège - ULiège > Département des sciences cliniques > Immunopathologie - Maladies infectieuses et médecine interne générale ; Département des Maladies Infectieuses, Hôpital de la Citadelle, 4000 Liège, Belgium
THYS, Marie ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des informations médico économiques (SIME)
Ernst, Marie  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des informations médico économiques (SIME)
Bourgeois, Marie-Eve;  Faculté de Médecine, Université de Liège, 4000 Liège, Belgium
Wagner, Léa ;  Faculté de Médecine, Université de Liège, 4000 Liège, Belgium
DELAHAYE, Thibaut  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de dermatologie
Darcis, Gilles  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des maladies infectieuses - médecine interne
Language :
English
Title :
Clinical Outcomes of Third-Generation Cephalosporin Definitive Therapy for Bloodstream Infections Due to Enterobacterales with Potential AmpC Induction: A Single-Center Retrospective Study.
Publication date :
11 September 2023
Journal title :
Pathogens (Basel, Switzerland)
ISSN :
2076-0817
eISSN :
2076-0817
Publisher :
Multidisciplinary Digital Publishing Institute (MDPI), Switzerland
Volume :
12
Issue :
9
Pages :
1152
Peer reviewed :
Peer reviewed
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since 08 January 2024

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