Fluoroquinolone therapy for bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae
Journal
Journal of Microbiology, Immunology and Infection
Journal Volume
50
Journal Issue
3
Pages
355-361
Date Issued
2017
Author(s)
Abstract
Background/Purpose For extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae infections, carbapenems are recommended as first line therapy, and clinical data on the therapeutic efficacy of fluoroquinolones (FQs) is limited. This study compares the efficacy of FQs and carbapenems for bloodstream infections caused by ESBL-producing Escherichia coli or Klebsiella pneumoniae. Methods Between 2008 and 2010, adults with ESBL-producing E. coli or K. pneumoniae bacteremia at two medical centers were reviewed. Adults receiving definitive FQ or carbapenem therapy were compared in a propensity score-matched analysis, and 30-day mortality was the primary endpoint. Results A total of 299 patients were eligible. Patients receiving a FQ (n = 24), either ciprofloxacin or levofloxacin, had a lower 30-day mortality rate than those with carbapenem therapy (8.3%, 2/24 vs. 23.3%, 64/275; p = 0.12). Multivariate regression analysis revealed that a critical illness [Pitt bacteremia score ? 4 points; odds ratio (OR), 7.09; p < 0.001], rapidly fatal underlying disease (OR, 5.73; p < 0.001), and hospital-associated infection (OR, 2.57; p = 0.01) were independently associated with 30-day mortality. By contrast, FQ definitive therapy was a protective factor compared with carbapenems (OR, 0.18; p = 0.04). There were 72 matched cases with carbapenem therapy in a propensity score-matched analysis, and a difference in the 30-day mortality rate of two groups was noted (8.3% vs. 29.2%; p = 0.05). Conslusion For ESBL-producing E. coli or K. pneumoniae bacteremia, ciprofloxacin or levofloxacin, if active in vitro, can be considered as a carbapenem-sparing alternative. ? 2015
SDGs
Other Subjects
carbapenem derivative; ciprofloxacin; corticosteroid; ertapenem; imipenem; levofloxacin; meropenem; antiinfective agent; beta lactamase; carbapenem derivative; quinolone derivative; adult; antibacterial activity; antibiotic therapy; Article; bloodstream infection; clinical evaluation; comparative study; controlled study; critical illness; disease assessment; disease association; drug efficacy; extended spectrum beta lactamase producing Escherichia coli; extended spectrum beta lactamase producing Klebsiella pneumoniae; female; hospital infection; human; major clinical study; male; mortality rate; multicenter study; outcome assessment; Pitt bacteremia score; aged; bacteremia; enzymology; Escherichia coli; Escherichia coli infection; isolation and purification; Klebsiella infection; Klebsiella pneumoniae; microbiology; middle aged; retrospective study; secretion (process); survival analysis; treatment outcome; very elderly; young adult; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Carbapenems; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Humans; Klebsiella Infections; Klebsiella pneumoniae; Middle Aged; Retrospective Studies; Survival Analysis; Treatment Outcome; Young Adult
Type
journal article