3児の親さん薬剤師のブログ

とある薬剤師です。感染症治療を考える素材をちょこっと提供。https://note.mu/twin1980。

Role of Early De-escalation of Antimicrobial Therapy on Risk of Clostridioides difficile Infection following Enterobacteriaceae Bloodstream Infections

CIDに報告された、腸内細菌血流感染症後のCDIリスクと早期のDE

 

academic.oup.com

 感想

 

48時間以内のAPBLからのDe-escalationは、大変です。

現状は、72時間かかることも多い、、

病原菌特定につながる、仕組み化強化しないといけない。

 

早期De-escalationの重要性は再確認できた。

 

APBL : antipseudomonal beta-lactams

 

Abstract

Background

There is a paucity of data on the effect of early de-escalation of antimicrobial therapy on rates of Clostridioides difficile infection (CDI). This retrospective cohort study evaluated impact of de-escalation from antipseudomonal beta-lactams (APBL) within 48 hours of Enterobacteriaceae bloodstream infections (BSI) on 90-day risk of CDI.

Methods

Adult patients hospitalized for >48 hours for treatment of EnterobacteriaceaeBSI at Palmetto Health hospitals in Columbia, SC, USA, from January 1, 2011 through June 30, 2015 were identified. Multivariable Cox proportional hazards regression was used to examine time to CDI in patients who received >48 hours and ≤48 hours of APBL for empirical therapy of EnterobacteriaceaeBSI after adjustment for the propensity to receive >48 hours of APBL.

Results

Among 808 patients with Enterobacteriaceae BSI, 414 and 394 received >48 and ≤48 hours of APBL, respectively. Incidence of CDI was higher in patients who received >48 hours than those who received ≤48 hours of APBL (7.0% vs. 1.8%; log-rank p=0.002). After adjustment for propensity to receive >48 hours of APBL and other variables in the multivariable model, receipt of >48 hours of APBL (hazard ratio [HR] 3.38, 95% confidence intervals [CI]: 1.40-9.47, p=0.006) and end-stage renal disease (HR 4.04, 95% CI: 1.75-8.78; p=0.002) were independently associated with higher risk of CDI.

Conclusions

The empirical use of APBL for >48 hours was an independent risk factor for CDI. Early de-escalation of APBL using clinical risk assessment tools or rapid diagnostic testing may reduce the incidence of CDI in hospitalized adults with Enterobacteriaceae BSI.