Clinical evaluation of cefotiam in the treatment of bacteremia caused by Escherichia coli, Klebsiella species, and Proteus mirabilis: A retrospective study
Clinical evaluation of cefotiam in the treatment of bacteremia caused by Escherichia coli, Klebsiella species, and Proteus mirabilis: A retrospective study
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DOI：
10.1016/j.jiac.2020.06.007
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发表时间：
2020-11-01
影响因子：
2.2
通讯作者：
Saito, Hideyuki
中科院分区：
文献类型：
--
作者：
Hashiguchi, Yumi;Oda, Kazutaka;Saito, Hideyuki
菌血症通常由革兰氏阴性菌（以EKP为代表;大肠杆菌、克雷伯氏菌属和奇异变形杆菌）引起，头孢唑林作为其治疗中的一线抗菌药物的过度使用一直是耐药菌株出现的一个担忧来源。作为一种抗菌剂，头孢替安可能是头孢唑林的替代品;然而，几乎没有证据表明其用于治疗菌血症。本非劣效性研究的目的是回顾性比较头孢替安与某些窄谱抗菌药物（头孢唑林、头孢美唑和氟氧头孢）治疗EKP诱导菌血症的疗效。头孢替安组招募了32例患者，对照组招募了29例患者。在主要终点中，头孢替安组和对照组第28天的生存率分别为93.5%和89.3%（第28天的相对风险为1.048; 95%置信区间为0.894 - 1.227）。在次要终点中，两组的治疗成功率分别为71.9%和69.0%（相对风险，1.042; 95%置信区间，0.752 - 1.445）。重症监护室入院、低体重、低白蛋白血症和与尿路无关的感染被确定为治疗失败的危险因素。我们证明头孢替安在EKP诱导的菌血症中的存活率方面可能不劣于其他相似谱的抗菌药物。(c)2020年日本化疗学会和日本传染病协会。由爱思唯尔有限公司出版。保留所有权利。
Bacteremia is often caused by gram-negative bacteria (represented by EKP; Escherichia coli, Klebsiella species, and Proteus mirabilis), and the excessive use of cefazolin, as the first-line antimicrobial in its treatment, has been a source of concern in the emergence of resistant strains. As an antimicrobial, cefotiam may be an alternative to cefazolin; however, little evidence is available for its use in the treatment of bacteremia. The purpose of this non-inferiority study was to retrospectively compare the therapeutic efficacy of cefotiam with some antimicrobials of narrow spectrum (cefazolin, cefmetazole, and flomoxef) in the treatment of EKP-induced bacteremia. The number of patients recruited was 32 in the cefotiam group and 29 in the control group. In the primary endpoint, the survival rate on day 28 for the cefotiam group and the control group was 93.5% and 89.3%, respectively (relative risk at day 28, 1.048; 95% confidence interval, 0.894-1.227). In the secondary end point, treatment success rate in the two groups was 71.9% and 69.0%, respectively (relative risk, 1.042; 95% confidence interval, 0.752-1.445). Intensive care unit admission, low body weight, hypoalbuminemia, and infections unassociated with the urinary tract were identified to be the risk factors responsible for treatment failure. We demonstrated cefotiam may be non-inferior to other antimicrobials of similar spectrum, in terms of survival rate, in EKP-induced bacteremia. (c) 2020 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.