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首页> 外文期刊>Annals of Clinical Microbiology and Antimicrobials >Comparison of therapy with β-lactam/β-lactamase inhibitor combinations or carbapenems for bacteraemia of nonurinary source caused by ESBL-producing Escherichia coli or Klebsiella pneumoniae
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Comparison of therapy with β-lactam/β-lactamase inhibitor combinations or carbapenems for bacteraemia of nonurinary source caused by ESBL-producing Escherichia coli or Klebsiella pneumoniae

机译：β-内酰胺/β-乳酰胺酶抑制剂组合或碳癌患者对由ESBL的大肠杆菌或Klebsiella肺炎引起的非源性菌血症的β-内酰胺/β-乳酰胺酶抑制剂组合的比较或Carbapems

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Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae has become a public health concern. This study aimed to compare the clinical outcomes of patients with nonurinary source bacteraemia caused by ESBL-producing Escherichia coli (E. coli) or Klebsiella pneumoniae (ESBL-producing EK) receiving β-lactam/β-lactamase inhibitor combinations (BLICs) versus carbapenem treatment and assess the risk factors of mortality with these two drugs. We conducted a retrospective single-centre study of adult hospitalised patients with ESBL-producing EK bloodstream infection (BSI) from nonurinary source at our centre over a 4-year period. One hundred and eighty patients who received BLICs or carbapenems were included in the analysis. The outcome variables were 14-day treatment failure and 30-day mortality. For more reliable results, propensity score analysis was performed to compare the efficacy of the two drugs and analyse their risk factors for 30-day mortality. Out of 180 patients, 114 received BLICs, and 66 received carbapenem therapy. Compared to carbapenem-treated patients, those treated with BLICs were older and had higher age-adjusted Charlson comorbidity index, but they had shorter stay in the hospital. Additionally, their Pitt bacteraemia score, SOFA score, rate of leukaemia, and immune compromise were lower. After propensity score matching (PSM), the baseline characteristics of patients in the two treatment groups were balanced. BLICs were associated with a higher 14-day treatment failure rate (20.6%, 13/63) than carbapenems (16.3%, 7/43), although the difference was not significant in either univariate analysis (P?=?0.429) or multivariate analysis (P?=?0.122). And the 30-day mortality rate in BTG (11.1%, 7/63) and CTG (11.6%, 5/43) did not significantly differ (univariate analysis, P?=?0.926; multivariate analysis, P?=?0.420). In the multivariate analysis, after PSM, leukaemia was the only independent predictor of mortality in both BTG and CTG. Our study showed that BLICs had higher 14-day treatment failure rate compared with carbapenems, although there were no statistically significant differences because of the small number of patients, therefore, further evaluation of the efficacy of BLICs is needed.
机译：扩展光谱β-乳酰胺酶（ESBL） - 发放肠杆菌菌已成为公共卫生问题。本研究旨在比较由ESBL-产生的Escherichia Coli（大肠杆菌）或Klebsiella肺炎（ESBL-生成EK）引起的非核来源患者的临床结果，接受β-内酰胺/β-内酰胺酶抑制剂组合（BLICS）与CarbapeNem治疗和评估这两种药物死亡率的危险因素。我们在4年期间，对来自我们中心的非核来源的ESBL-产生EK血流感染（BSI）进行了对成人住院患者的回顾性单中心研究。分析中包括一百八十名接受Blics或Carbapems的患者。结果变量为14天治疗失败和30天的死亡率。为了更可靠的结果，进行倾向分数分析以比较两种药物的疗效，并分析其30天死亡率的危险因素。在180名患者中，114名接受的BLICS，66名接受了肉豆蔻治疗。与Carbapenem治疗的患者相比，用BLICS治疗的患者年龄较大，并且具有更高的年龄调整的Charlson合并症指数，但他们在医院留下了更短的逗留。此外，它们的皮特菌血症评分，沙发评分，白血病率和免疫折衷都较低。在倾向得分匹配（PSM）之后，两种治疗组患者的基线特征是平衡的。 BLICS与比肉豆蛋白（16.3％，7/43）的14天治疗失败率（20.6％，13/63）相关，尽管在单变量分析中差异不显着（p？= 0.429）或多变量分析（p？= 0.122）。和BTG的30天死亡率（11.1％，7/63）和CTG（11.6％，5/43）没有显着差异（单变量分析，P？= 0.926;多变量分析，P？= 0.420） 。在多变量分析中，在PSM之后，白血病是BTG和CTG中唯一的死亡率的独立预测因子。我们的研究表明，与肉豆蔻蛋白相比，BLICS具有更高的14天治疗失败率，尽管由于少数患者而没有统计学意义差异，因此，需要进一步评估BLOS的功效。

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