https://doi.org/10.1016/j.jgar.2019.12.015

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Document Type

Article

Subject Area(s)

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)

Abstract

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)

https://doi.org/10.1016/j.jgar.2019.12.015

APA Citation

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

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