Adult; Aged; Anti-Bacterial Agents (pharmacology, therapeutic use); Bacteremia (drug therapy); Drug Resistance, Bacterial; Female; Fluoroquinolones (pharmacology, therapeutic use); Gram-Negative Bacterial Infections (drug therapy); Humans; Male; Retrospective Studies; Risk Factors; Sepsis (drug therapy); beta-Lactams (pharmacology, therapeutic use)
OBJECTIVES: Increasing antimicrobial resistance rates limit empirical antimicrobial treatment options for Gram-negative bloodstream infections (GN-BSI). However, antimicrobial resistance may be predicted based on patient-specific risk factors using precision medicine concepts. This retrospective, 1:2 matched cohort examined clinical outcomes in hospitalized adults without major risk factors for antimicrobial resistance receiving empirical fluoroquinolones or broad-spectrum beta-lactams (BSBL) for GN-BSI at Prisma Health-Midlands hospitals in Columbia, SC, USA from January 2010 through June 2015. METHODS: Multivariable logistic regression was used to examine early treatment failure at 72-96 h from GN-BSI. Cox proportional hazards regression was used to examine 28-day mortality and hospital length of stay (HLOS). RESULTS: Among 74 and 148 patients receiving empirical fluoroquinolones and BSBL for GN-BSI, respectively, median age was 68 years, 159 (72%) were women, and 152 (68%) had a urinary source of infection. Early treatment failure rates were comparable in fluoroquinolone and BSBL groups (27% vs. 30%, respectively, odds ratio 0.82, 95% confidence intervals [CI] 0.43-1.54, P = 0.53), as well as 28-day mortality (8.9% vs. 9.7%, respectively, hazards ratio [HR] 0.74, 95% CI 0.26-1.90, P = 0.54). Median HLOS was 6.1 days in the fluoroquinolone group and 7.1 days in the BSBL group (HR 0.73, 95% CI 0.54-0.99, P = 0.04). Transition from intravenous to oral therapy occurred sooner in the fluoroquinolone group than in the BSBL group (3.0 vs. 4.9 days, P < 0.001). CONCLUSIONS: In the absence of antimicrobial resistance risk factors, fluoroquinolones provide an additional empirical treatment option to BSBL for GN-BSI. Shorter HLOS in the fluoroquinolone group may be due to earlier transition from intravenous to oral antimicrobial therapy.
Digital Object Identifier (DOI)
Published in Journal of Global Antimicrobial Resistance, Volume 22, 2020, pages 87-93.
http://dx.doi.org/10.1016/j.jgar.2019.12.015 2213-7165/© 2019 International Society for Antimicrobial Chemotherapy. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Al-Hasan, M., Gould, A., Drennan, C., Hill, O., Justo, J., Kohn, J., & Bookstaver, P. (2020). Empirical fluoroquinolones versus broad-spectrum beta-lactams for Gram-negative bloodstream infections in the absence of antimicrobial resistance risk factors. Journal Of Global Antimicrobial Resistance, 22, 87-93. https://doi.org/10.1016/j.jgar.2019.12.015