Are hematopoietic cell transplant recipients with Gram-negative bacteremia spending more time outpatient while on intravenous antibiotics? Addressing trends over 10 years at a single center.
Are hematopoietic cell transplant recipients with Gram-negative bacteremia spending more time outpatient while on intravenous antibiotics? Addressing trends over 10 years at a single center.
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DOI：
10.1002/iid3.486
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Pergam SA *
中科院分区：
文献类型：
--
作者：
Lind ML;Roncaioli S;Liu C;Bryan A;Sweet A;Tverdek F;Sorror M;Phipps AI *;Pergam SA *
门诊同种异体造血细胞移植 (HCT) 比例的不断增加，加上每日一次广谱抗生素的使用机会增加，以及门诊抗生素治疗可能比住院治疗更安全、成本更低的证据表明，患有革兰氏阴性杆菌菌血症 (GNRB) 的同种异体造血细胞移植受者越来越多地在门诊护理机构接受治疗。利用 2007 年至 2016 年间在单一中心移植的同种异体 HCT 受者移植后前 100 天内发生的首次 GNRB 事件的数据，我们估计了 GNRB 发病率和 GNRB 治疗管理的时间趋势，并确定患者或感染特征是否影响观察到的趋势。观察到的同种异体 HCT 受者中，共有 11% (238/2165) 经历了 ≥1 GNRB，具有可用的耐药性数据，并贡献了抗生素治疗时间。平均而言，患者在门诊接受了 55.1% 的抗生素治疗，我们观察到门诊治疗时间比例显着下降（粗值：-3.3% [95% 置信区间：-5.0，-1.6%]）。我们观察到，在具有相似 GNRB 和移植前复杂性因素的患者中，门诊治疗时间比例也出现了类似的下降，但在具有相似移植后并发症的患者中则没有（p 值：0.165）。这些结果表明，尽管门诊合适的治疗方案的可用性有所增加，但接受 GNRB 的同种异体 HCT 受者在门诊接受的治疗较少。然而，在具有类似移植后并发症的患者中，没有显着下降表明，对于具有类似移植后并发症的患者，治疗地点的决定仍然一致。这些发现表明，需要针对接受 GNRB 的同种异体 HCT 接受者进行门诊抗生素治疗采取额外的干预措施。在 10 年的时间里，革兰氏阴性杆菌菌血症 (GNRB) 的发生率和门诊 GNRB 治疗时间的比例显着下降。然而，在具有类似移植后并发症的患者中，没有观察到门诊治疗量下降。这表明门诊抗生素天数的减少可能与移植后并发症发生频率的增加有关。
The increasing proportion of outpatient allogeneic hematopoietic cell transplants (HCTs) coupled with increased access of once‐daily broad‐spectrum antibiotics and evidence that outpatient antibiotic treatment may be safer and less costly than inpatient treatment, suggest that allogeneic HCT recipients with Gram‐negative rod bacteremia (GNRBs) are increasingly being treated in ambulatory care settings. Using data from the first GNRB event that occurred within the first 100 days posttransplantation among allogeneic HCT recipients transplanted at a single center between 2007 and 2016, we estimated the temporal trends in GNRB incidence and treatment management of GNRBs and identified if patient or infection characteristics impacted observed trends. A total of 11% (238/2165) of the observed allogeneic HCT recipients experienced ≥1 GNRB with available resistance data and contributed antibiotic treatment time. Patients, on average, received 55.1% of their antibiotic treatment in an outpatient setting and we observed a significant decline in the proportion of treatment time spent outpatient (crude: −3.3% [95% confidence interval: −5.0, −1.6%]). We observed similar declines in the proportion of treatment time spent outpatient among patients with similar GNRB and pretransplant complexity factors but not among patients with similar posttransplant complications (p value: .165). These results suggest that, despite increased availability of outpatient suitable treatment options, allogeneic HCT recipients with GNRBs received less treatment in outpatient settings. However, among patients with similar posttransplant complications, the lack of significant decline suggests that treatment location decisions remained consistent for patients with similar posttransplant complications. These findings suggest the need for additional interventions targeting outpatient antibiotic treatment among allogeneic HCT recipients with GNRBs. Over a 10‐year period, Gram‐negative rod bacteremia (GNRB) incidence and the proportion of GNRBs treatment time spent outpatient declined significantly. However, among patients with similar posttransplant complications, no decline in outpatient treatment was observed. This suggests that the decline in outpatient antibiotic days may be linked to increased frequency of posttransplant complications.
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影响因子：
24.7
作者：
Levine, John E.;Braun, Thomas M.;Harris, Andrew C.;Holler, Ernst;Taylor, Austin;Miller, Holly;Magenau, John;Weisdorf, Daniel J.;Ho, Vincent T.;Bolanos-Meade, Javier;Alousi, Amin M.;Ferrara, James L. M.
通讯作者：
Ferrara, James L. M.
影响因子：
14.2
作者：
Magiorakos, A. -P.;Srinivasan, A.;Monnet, D. L.
通讯作者：
Monnet, D. L.
影响因子：
4.8
作者：
Kanda, Y;Mineishi, S;Takaue, Y
通讯作者：
Takaue, Y
DOI：
10.1155/2016/8435257
发表时间：
2016-01-01
影响因子：
2.8
作者：
Yan, Marie;Elligsen, Marion;Daneman, Nick
通讯作者：
Daneman, Nick
影响因子：
4.3
作者：
Stohs, Erica;Chow, Victor A.;Pergam, Steven A.
通讯作者：
Pergam, Steven A.