Intravenous to oral antibiotics versus intravenous antibiotics: a step-up or a step-down for extended spectrum β-lactamase (ESBL)-producing urinary tract infections without concomitant bacteraemia?
Intravenous to oral antibiotics versus intravenous antibiotics: a step-up or a step-down for extended spectrum β-lactamase (ESBL)-producing urinary tract infections without concomitant bacteraemia?
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DOI：
10.1016/j.ijantimicag.2022.106541
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发表时间：
2022-03-08
影响因子：
10.8
通讯作者：
Sapozhnikov, Julia
中科院分区：
文献类型：
--
作者：
Gamble, Kelly C.;Rose, Dusten T.;Sapozhnikov, Julia
美国传染病协会（IDSA）推荐了许多抗生素用于治疗由产超广谱β-内酰胺酶（ESBL）细菌引起的尿路感染（UTI）。本研究的目的是评价口服降压抗生素与持续静脉治疗无菌血症的尿路感染的临床结局。这项多中心、回顾性、队列研究在2016年7月至2020年3月期间住院的产ESBL UTI患者中进行。主要结局是复合全因临床失败，定义为30天再次入院、30天住院死亡或住院期间口服抗生素的变化。次要结局包括个体主要结局组成部分、因复发性UTI而再次入院、住院期间抗生素的变化、住院时间（LOS）、抗生素费用和不良事件。该研究包括153名患者。两组的主要结局发生率均为28%（27/95 vs. 16/58; P = 0.91）。主要结局组成相似：再次入院（26% vs. 26%; P = 0.95）;住院死亡率（2% vs. 2%; P = 1.0）;抗生素变化（0% vs. 2%; P = 0.38）。平均住院时间和直接抗生素费用分别为8&PLUSMN; 6 d vs. 5&PLUSMN; 2 d（P <0.01）和278&PLUSMN; 244美元vs. 180&PLUSMN; 104美元（P <0.01）。除腹泻外，不良事件相似（15% vs. 2%; P = 0.01）。两组之间在临床失败、再入院率、因复发性UTI再入院、死亡率或抗生素变化方面没有差异。转换组与降低医院LOS和住院抗生素费用有关。(C)2022爱思唯尔有限公司和国际抗菌药物化学治疗学会。All rights reserved.
The Infectious Diseases Society of America (IDSA) recommends numerous antibiotics for the treatment of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria. The purpose of this study was to evaluate clinical outcomes of oral step-down antibiotics compared with continued intravenous therapy in UTIs without bacteraemia. This multicentre, retrospective, cohort study was conducted in hospitalised patients with ESBL-producing UTIs between July 2016 and March 2020. The primary outcome was a composite all-cause clinical failure, defined as 30-day re-admission, 30-day hospital mortality or a change in oral antibiotics during hospitalisation. Secondary outcomes included individual primary outcome components, re-admission due to a recurrent UTI, change in antibiotic during hospitalisation, hospital length of stay (LOS), antibiotic costs and adverse events. The study included 153 patients. The primary outcome occurred in 28% of both groups (27/95 vs. 16/58; P = 0.91). The primary outcome components were similar: re-admission (26% vs. 26%; P = 0.95); hospital mortality (2% vs. 2%; P = 1.0); and change in antibiotics (0% vs. 2%; P = 0.38). Mean hospital LOS and direct antibiotic costs were 8 & PLUSMN; 6 days vs. 5 & PLUSMN; 2 days ( P < 0.01) and US$278 & PLUSMN; 244 vs. US$180 & PLUSMN; 104 ( P < 0.01), respectively. Adverse events were similar, except diarrhoea (15% vs. 2%; P = 0.01). There was no difference in clinical failure, re-admission rate, re-admission due to a recurrent UTI, mortality rate or antibiotic change between groups. The switch group was associated with reduced hospital LOS and inpatient antibiotic costs.(C) 2022 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.