Extended Infusion of β-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis: An Observational Multicenter Study.
Aged
Anti-Bacterial Agents
/ administration & dosage
Bacteremia
/ drug therapy
Female
Humans
Infusions, Intravenous
Liver Cirrhosis
/ complications
Male
Middle Aged
Piperacillin
/ administration & dosage
Prospective Studies
Retrospective Studies
Tazobactam
/ administration & dosage
Treatment Outcome
beta-Lactams
/ administration & dosage
bloodstream infection
continuous infusion
liver cirrhosis
β-lactam antibiotics
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
30 10 2019
30 10 2019
Historique:
received:
12
09
2018
accepted:
10
01
2019
pubmed:
17
1
2019
medline:
26
9
2020
entrez:
17
1
2019
Statut:
ppublish
Résumé
We analyzed the impact of continuous/extended infusion (C/EI) vs intermittent infusion of piperacillin-tazobactam (TZP) and carbapenems on 30-day mortality of patients with liver cirrhosis and bloodstream infection (BSI). The BICRHOME study was a prospective, multicenter study that enrolled 312 cirrhotic patients with BSI. In this secondary analysis, we selected patients receiving TZP or carbapenems as adequate empirical treatment. The 30-day mortality of patients receiving C/EI or intermittent infusion of TZP or carbapenems was assessed with Kaplan-Meier curves, Cox-regression model, and estimation of the average treatment effect (ATE) using propensity score matching. Overall, 119 patients received TZP or carbapenems as empirical treatment. Patients who received C/EI had a significantly lower mortality rate (16% vs 36%, P = .047). In a Cox-regression model, the administration of C/EI was associated with a significantly lower mortality (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.11-0.936; P = .04) when adjusted for severity of illness and an ATE of 25.6% reduction in 30-day mortality risk (95% CI, 18.9-32.3; P < .0001) estimated with propensity score matching. A significant reduction in 30-day mortality was also observed in the subgroups of patients with sepsis (HR, 0.21; 95% CI, 0.06-0.74), acute-on-chronic liver failure (HR, 0.29; 95% CI, 0.03-0.99), and a model for end-stage liver disease score ≥25 (HR, 0.26; 95% CI, 0.08-0.92). At competing risk analysis, C/EI of beta-lactams was associated with significantly higher rates of hospital discharge (subdistribution hazard [95% CI], 1.62 [1.06-2.47]). C/EI of beta-lactams in cirrhotic patients with BSI may improve outcomes and facilitate earlier discharge.
Sections du résumé
BACKGROUND
We analyzed the impact of continuous/extended infusion (C/EI) vs intermittent infusion of piperacillin-tazobactam (TZP) and carbapenems on 30-day mortality of patients with liver cirrhosis and bloodstream infection (BSI).
METHODS
The BICRHOME study was a prospective, multicenter study that enrolled 312 cirrhotic patients with BSI. In this secondary analysis, we selected patients receiving TZP or carbapenems as adequate empirical treatment. The 30-day mortality of patients receiving C/EI or intermittent infusion of TZP or carbapenems was assessed with Kaplan-Meier curves, Cox-regression model, and estimation of the average treatment effect (ATE) using propensity score matching.
RESULTS
Overall, 119 patients received TZP or carbapenems as empirical treatment. Patients who received C/EI had a significantly lower mortality rate (16% vs 36%, P = .047). In a Cox-regression model, the administration of C/EI was associated with a significantly lower mortality (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.11-0.936; P = .04) when adjusted for severity of illness and an ATE of 25.6% reduction in 30-day mortality risk (95% CI, 18.9-32.3; P < .0001) estimated with propensity score matching. A significant reduction in 30-day mortality was also observed in the subgroups of patients with sepsis (HR, 0.21; 95% CI, 0.06-0.74), acute-on-chronic liver failure (HR, 0.29; 95% CI, 0.03-0.99), and a model for end-stage liver disease score ≥25 (HR, 0.26; 95% CI, 0.08-0.92). At competing risk analysis, C/EI of beta-lactams was associated with significantly higher rates of hospital discharge (subdistribution hazard [95% CI], 1.62 [1.06-2.47]).
CONCLUSIONS
C/EI of beta-lactams in cirrhotic patients with BSI may improve outcomes and facilitate earlier discharge.
Identifiants
pubmed: 30649218
pii: 5289194
doi: 10.1093/cid/ciz032
doi:
Substances chimiques
Anti-Bacterial Agents
0
beta-Lactams
0
Tazobactam
SE10G96M8W
Piperacillin
X00B0D5O0E
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1731-1739Investigateurs
Caterina Campoli
(C)
Renato Pascale
(R)
Andreas Stallmach
(A)
Mario Venditti
(M)
Cristina Lucidi
(C)
Serena Ludovisi
(S)
Marina de Cueto
(M)
Navarro Maria Dolores
(NM)
Lopez Cortes Eduardo
(LC)
Emilo Bouza
(E)
Maricela Valerio
(M)
Alia Eworo
(A)
Raffaella Losito
(R)
Marco Senzolo
(M)
Elena Nadal
(E)
Antonio Ottobrelli
(A)
Martina Varguvic
(M)
Cristina Badia
(C)
Borgia Guglielmo
(B)
Ivan Gentile
(I)
Antonio Riccardo Buonomo
(AR)
Evangelo Boumis
(E)
Alicia Beteta-Lopez
(A)
Alessia Rianda
(A)
Gloria Taliani
(G)
Stefania Grieco
(S)
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.