How Broad Should Gram-Negative Coverage Be for Febrile Parenteral Nutrition Dependent Short Bowel Syndrome Patients?
How Broad Should Gram-Negative Coverage Be for Febrile Parenteral Nutrition Dependent Short Bowel Syndrome Patients?
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DOI：
10.1097/mpg.0000000000003382
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发表时间：
2022-06-01
影响因子：
2.9
通讯作者：
Lee, Kelley R.
中科院分区：
文献类型：
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作者：
Stultz, Jeremy S.;Fly, James H.;Bagga, Bindiya;Arnold, Sandra R.;Algotar, Anushree;Lee, Kelley R.
关键词：
与经验性地用于住院获得性中心静脉导管相关血流感染（CLABSI）相比，在接受家庭肠外营养的发热性短肠综合征（SBS）患者中，通常经验性地使用广谱革兰氏阴性抗生素治疗中心静脉导管相关血流感染（CLABSI）。该分析报告了5年内22例社区SBS患者发生57例CLABSI，76例患者发生78例住院获得性CLABSI。SBS和住院患者获得性队列之间的革兰氏阴性CLABSI比例相似（分别为43.8%和42.3%，p=0.78）。在SBS和住院患者获得性队列中，分别有1.8%和10.3%（p=0.125）的革兰氏阴性CLABSI对头孢曲松不敏感，0%和3.8%（p=0.52）对头孢他啶不敏感。在SBS队列中，家庭乙醇封管治疗和既往培养结果影响革兰氏阴性病原体分布。与住院患者相比，SBS患者中CLABSI的经验性革兰氏阴性覆盖范围更广是不必要的。第三代头孢菌素代表了从社区到我们机构的发热SBS患者的适当经验性革兰氏阴性药物。
Broader spectrum gram-negative antibiotics are commonly utilized empirically for central line-associated bloodstream infections (CLABSI) in febrile short bowel syndrome (SBS) patients receiving home parenteral nutrition compared to those used empirically for inpatient-acquired CLABSI. This analysis reports 57 CLABSI in 22 patients with SBS admitted from the community and 78 inpatient-acquired CLABSI in 76 patients over a 5-year period. Proportional gram-negative CLABSI was similar between the SBS and inpatient-acquired cohorts (43.8% versus 42.3%, respectively, p=0.78). 1.8% and 10.3% (p=0.125) of gram-negative CLABSI were non-susceptible to ceftriaxone and 0% and 3.8% (p=0.52) were non-susceptible to ceftazidime in the SBS and inpatient-acquired cohorts, respectively. In the SBS cohort, home ethanol lock therapy and prior culture results impacted gram-negative pathogen distribution. Broader empiric gram-negative coverage for CLABSI among SBS patients compared to inpatients is unnecessary. Third-generation cephalosporins represent appropriate empiric gram-negative agents for febrile SBS patients presenting from the community to our institution.