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Seven-day antibiotic therapy for Enterobacterales bacteremia in high-risk neutropenic patients: toward a new paradigm.
Herrera, Fabián; Torres, Diego; Laborde, Ana; Jordán, Rosana; Tula, Lucas; Mañez, Noelia; Pereyra, María Laura; Suchowiercha, Nadia; Berruezo, Lorena; Gudiol, Carlota; Ibáñez, María Luz González; Eusebio, María José; Lambert, Sandra; Barcán, Laura; Rossi, Inés Roccia; Nicola, Federico; Pennini, Magdalena; Monge, Renata; Blanco, Miriam; Visús, Mariángeles; Reynaldi, Mariana; Carbone, Ruth; Pasterán, Fernando; Corso, Alejandra; Rapoport, Melina; Carena, Alberto Angel.
Afiliação
  • Herrera F; Infectious Diseases Section, Internal Medicine Department, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Av. Galván 4102 (C1431), Buenos Aires, Argentina. fabian1961@gmail.com.
  • Torres D; Infectious Diseases Section, Internal Medicine Department, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Av. Galván 4102 (C1431), Buenos Aires, Argentina.
  • Laborde A; Infectious Diseases Service, Fundación Para Combatir La Leucemia (FUNDALEU), Buenos Aires, Argentina.
  • Jordán R; Infectious Diseases Service, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
  • Tula L; Infectious Diseases Service, Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina.
  • Mañez N; Infectious Diseases Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
  • Pereyra ML; Infectious Diseases Service, Hospital Universitario Austral, Buenos Aires, Argentina.
  • Suchowiercha N; Infectious Diseases Service, Hospital Interzonal General de Agudos (HIGA) Gral. San Martín de La Plata, Buenos Aires, Argentina.
  • Berruezo L; Infectious Diseases Service, Hospital Interzonal General de Agudos (HIGA), Prof. Dr. Rodolfo Rossi de La Plata, Buenos Aires, Argentina.
  • Gudiol C; Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Barcelona, España.
  • Ibáñez MLG; Infectious Diseases Service, Fundación Para Combatir La Leucemia (FUNDALEU), Buenos Aires, Argentina.
  • Eusebio MJ; Infectious Diseases Service, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
  • Lambert S; Infectious Diseases Service, Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina.
  • Barcán L; Infectious Diseases Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
  • Rossi IR; Infectious Diseases Service, Hospital Interzonal General de Agudos (HIGA) Gral. San Martín de La Plata, Buenos Aires, Argentina.
  • Nicola F; Microbiology Laboratory, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina.
  • Pennini M; Microbiology Laboratory, Centro de Estudios Infectológicos (CEI) Dr. Stamboulian, Buenos Aires, Argentina.
  • Monge R; Microbiology Service, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
  • Blanco M; Microbiology Laboratory, Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina.
  • Visús M; Bacteriology Laboratory, Central Laboratory, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
  • Reynaldi M; Microbiology Laboratory, Hospital Interzonal General de Agudos (HIGA), Gral. San Martín de La Plata, Buenos Aires, Argentina.
  • Carbone R; Bacteriology Laboratory, Hospital Interzonal General de Agudos (HIGA) Prof. Dr. Rodolfo Rossi de La Plata, Buenos Aires, Argentina.
  • Pasterán F; Antimicrobials Service, INEI-ANLIS Dr. Carlos Malbrán, Buenos Aires, Argentina.
  • Corso A; Antimicrobials Service, INEI-ANLIS Dr. Carlos Malbrán, Buenos Aires, Argentina.
  • Rapoport M; Antimicrobials Service, INEI-ANLIS Dr. Carlos Malbrán, Buenos Aires, Argentina.
  • Carena AA; Infectious Diseases Section, Internal Medicine Department, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Av. Galván 4102 (C1431), Buenos Aires, Argentina.
Eur J Clin Microbiol Infect Dis ; 43(9): 1741-1751, 2024 Sep.
Article em En | MEDLINE | ID: mdl-38958809
ABSTRACT

PURPOSE:

Data on short courses of antibiotic therapy for Enterobacterales bacteremia in high-risk neutropenic patients are limited. The aim of the study was to describe and compare the frequency of bacteremia relapse, 30-day overall and infection-related mortality, Clostridiodes difficile infection and length of hospital stay since bacteremia among those who received antibiotic therapy for 7 or 14 days.

METHODS:

This is a multicenter, prospective, observational cohort study in adult high-risk neutropenic patients with hematologic malignancies or hematopoietic stem cell transplant and monomicrobial Enterobacterales bacteremia. They received appropriate empirical antibiotic therapy, had a clinical response within 7 days, and infection source control. Clinical, epidemiological and outcomes variables were compared based on 7 or 14 days of AT.

RESULTS:

Two hundred patients were included (100, 7-day antibiotic therapy; 100, 14-day antibiotic therapy). Escherichia coli was the pathogen most frequently isolated (47.5%), followed by Klebsiella sp. (40.5%). Among those patients that received 7-day vs. 14-day antibiotic course, a clinical source of bacteremia was found in 54% vs. 57% (p = 0.66), multidrug-resistant Enterobacterales isolates in 28% vs. 30% (p = 0.75), and 40% vs. 47% (p = 0.31) received combined empirical antibiotic therapy. Overall mortality was 3% vs. 1% (p = 0.62), in no case related to infection; bacteremia relapse was 7% vs. 2% (p = 0.17), and length of hospital stay since bacteremia had a median of 9 days (IQR 7-15) vs. 14 days (IQR 13-22) (p = < 0.001).

CONCLUSIONS:

These data suggest that seven-day antibiotic therapy might be adequate for patients with high-risk neutropenia and Enterobacterales bacteremia, who receive appropriate empirical therapy, with clinical response and infection source control.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Bacteriemia / Infecções por Enterobacteriaceae / Antibacterianos / Neutropenia Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Clin Microbiol Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS / MICROBIOLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Argentina País de publicação: Alemanha

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Bacteriemia / Infecções por Enterobacteriaceae / Antibacterianos / Neutropenia Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Clin Microbiol Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS / MICROBIOLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Argentina País de publicação: Alemanha