Clinical Impact of Ceftriaxone Resistance in Escherichia coli Bloodstream Infections: A Multicenter Prospective Cohort Study.
Clinical Impact of Ceftriaxone Resistance in Escherichia coli Bloodstream Infections: A Multicenter Prospective Cohort Study.
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DOI：
10.1093/ofid/ofac572
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发表时间：
2022-11
影响因子：
4.2
通讯作者：
中科院分区：
文献类型：
--
作者：
耐头孢曲松（CRO-R）大肠杆菌血流感染（BSI）很常见。这是一项前瞻性队列研究，研究对象为2020年11月至2021年4月期间美国14家医院的大肠杆菌BSI患者。对于入组的每例CRO-R大肠埃希菌BSI患者，纳入下一例头孢曲松敏感（CRO-S）大肠埃希菌BSI的连续患者。主要结局是第30天结局评级（DOOR）的可取性，CRO-R组中结局更差的概率为50%作为零假设。使用逆概率加权（IPW）来减少混杂。感染CRO-R和CRO-S大肠杆菌BSI的患者之间的显著差异包括Pitt菌血症评分≥4的比例（23% vs 15%，P = 0.079）和主动抗生素治疗的中位时间（12小时[四分位距{IQR}，1-35小时] vs 1小时[IQR，0-6小时]; P <0.001）。 未校正的DOOR分析表明，CRO-R与CRO-S BSI相比，临床结局更差的概率为58%（95%置信区间[CI]，52%-63%）。在IPW校正队列中，未观察到差异（54% [95% CI，47%-61%]）。次要结局包括CRO-R和CRO-S BSI之间30天死亡率比例的未校正和校正差异（分别为−5.3% [95% CI，−10.3%至−.4%]和−1.8 [95% CI，−6.7%至3.2%]），培养后中位住院时间（8天[IQR，5-13天] vs 6天[IQR，4-9天]; P <0.001），以及意外入院长期护理机构（22% vs 12%，P = 0.045）。与感染CRO-S大肠杆菌BSI的患者相比，CRO-R大肠杆菌BSI的患者通常具有较差的结局，即使在调整了重要的混杂因素之后。
Ceftriaxone-resistant (CRO-R) Escherichia coli bloodstream infections (BSIs) are common. This is a prospective cohort of patients with E coli BSI at 14 United States hospitals between November 2020 and April 2021. For each patient with a CRO-R E coli BSI enrolled, the next consecutive patient with a ceftriaxone-susceptible (CRO-S) E coli BSI was included. Primary outcome was desirability of outcome ranking (DOOR) at day 30, with 50% probability of worse outcomes in the CRO-R group as the null hypothesis. Inverse probability weighting (IPW) was used to reduce confounding. Notable differences between patients infected with CRO-R and CRO-S E coli BSI included the proportion with Pitt bacteremia score ≥4 (23% vs 15%, P = .079) and the median time to active antibiotic therapy (12 hours [interquartile range {IQR}, 1–35 hours] vs 1 hour [IQR, 0–6 hours]; P < .001). Unadjusted DOOR analyses indicated a 58% probability (95% confidence interval [CI], 52%–63%) for a worse clinical outcome in CRO-R versus CRO-S BSI. In the IPW-adjusted cohort, no difference was observed (54% [95% CI, 47%–61%]). Secondary outcomes included unadjusted and adjusted differences in the proportion of 30-day mortality between CRO-R and CRO-S BSIs (−5.3% [95% CI, −10.3% to −.4%] and −1.8 [95% CI, −6.7% to 3.2%], respectively), postculture median length of stay (8 days [IQR, 5–13 days] vs 6 days [IQR, 4–9 days]; P < .001), and incident admission to a long-term care facility (22% vs 12%, P = .045). Patients with CRO-R E coli BSI generally have poorer outcomes compared to patients infected with CRO-S E coli BSI, even after adjusting for important confounders.
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影响因子：
4.9
作者：
Diekema, Daniel J.;Hsueh, Po-Ren;Jones, Ronald N.
通讯作者：
Jones, Ronald N.
影响因子：
3.1
作者：
Bonine, Nicole Gidaya;Berger, Ariel;Lodise, Thomas
通讯作者：
Lodise, Thomas
影响因子：
4.9
作者：
Schwaber, MJ;Navon-Venezia, S;Carmeli, Y
通讯作者：
Carmeli, Y
影响因子：
3.4
作者：
Tamma PD;Humphries RM
通讯作者：
Humphries RM
影响因子：
4.2
作者：
Simner PJ;Rauch CA;Martin IW;Sullivan KV;Rhoads D;Rolf R;She R;Souers RJ;Wojewoda C;Humphries RM
通讯作者：
Humphries RM