Loading dose plus continuous/extended infusion versus intermittent bolus of ß-lactams for the treatment of Gram-negative bacteria bloodstream infections: a propensity score-adjusted retrospective cohort study.
J Antimicrob Chemother
; 78(9): 2175-2184, 2023 09 05.
Article
em En
| MEDLINE
| ID: mdl-37428015
ABSTRACT
BACKGROUND:
Optimal ß-lactam dosing for the treatment of Gram-negative bacteria bloodstream infections (GNB-BSIs) remains a debated issue. Herein, the efficacy and safety of a loading dose (LD) followed by extended/continuous infusion (EI/CI) versus intermittent bolus (IB) of these drugs for the treatment of GNB-BSIs was evaluated.METHODS:
This is a retrospective observational study enrolling patients with GNB-BSIs treated with ß-lactams from 1 October 2020 to 31 March 2022. The 30 day infection-related mortality rate was assessed with Cox regression, while mortality risk reduction was evaluated by an inverse probability of treatment weighting regression adjustment (IPTW-RA) model.RESULTS:
Overall, 224 patients were enrolled 140 and 84 in the IB and EI/CI groups, respectively. ß-Lactam regimens were chosen according to pathogen antibiogram, clinical judgement and current guidelines. Interestingly, the LDâ+âEI/CI regimen was associated with a significant lower mortality rate (17% versus 32%, Pâ=â0.011). Similarly, ß-lactam LDâ+âEI/CI was significantly associated with a reduced risk of mortality at multivariable Cox regression [adjusted HR (aHR)â=â0.46; 95%CIâ=â0.22-0.98; Pâ=â0.046]. Finally, the IPTW-RA (adjusted for multiple covariates) was performed, showing a significant risk reduction in the overall population [-14% (95% CIâ=â-23% to -5%)]; at the subgroup restricted analysis, a significant risk reduction (>15%) was observed in the case of GNB-BSI in severely immunocompromised patients (Pâ=â0.003), for SOFA scoreâ>â6 (Pâ=â0.014) and in septic shock (Pâ=â0.011).CONCLUSIONS:
The use of LDâ+âEI/CI of ß-lactams in patients with a GNB-BSI may be associated with reduced mortality; also in patients with severe presentation of infection or with additional risk factors, such as immunodepression.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por Bactérias Gram-Negativas
/
Bacteriemia
/
Sepse
Tipo de estudo:
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article