Clinical outcomes in OPAT patients treated with ceftriaxone 4 g and ceftazidime 6 g extended interval dosing regimens.

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-05-30 eCollection Date: 2024-06-01 DOI:10.1093/jacamr/dlae079
David Wareham, Mark Melzer
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Abstract

Background: New dosing regimens for ceftriaxone 4 g/24 hours and ceftazidime 3 g/12 hours are convenient for patients receiving OPAT. To date, these have not been clinically validated.

Aim: To assess the tolerability, toxicity and effectiveness of once daily ceftriaxone (4 g) and 12 hourly ceftazidime regimens (3 g twice a day) in the OPAT setting.

Patients and methods: From April 2018 until March 2023; demographic, clinical, microbiological and outcome data were collected on all adult patients discharged to a community-based OPAT team in East London.

Results: There were 487 OPAT episodes. Fifty-three (10.9%) patients received ceftriaxone 4 g once a day and 20 (4.1%) ceftazidime 3 g twice a day. In the ceftriaxone group, the commonest conditions treated were orthopaedic, neurosurgical or diabetic foot infections. OPAT was used to expedite the discharge of 45 (84.9%) patients, the remainder were admission avoidance episodes. The commonest isolate causing infection was MSSA 23 (43.4%). There were no tolerability or toxicity episodes recorded. All patients were cured and bed days saved were 1266.In the smaller twice-daily ceftazidime cohort, seven (35%) patients were treated for necrotizing otitis externa, six (30%) for bronchiectasis and six (30%) for urinary tract infections. The commonest cause of infection was P. aeruginosa, 18 (90%). One case of nephrotoxicity was recorded. All patients were cured and bed days saved were 896.

Conclusions: Regimens of ceftriaxone 4 g once a day and ceftazidime 3 g twice a day were well tolerated and highly effective. If widely adopted, these regimens will save OPAT and nursing time and enable more patients to be treated.

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采用头孢曲松 4 克和头孢唑肟 6 克延长间隔给药方案治疗 OPAT 患者的临床疗效。
背景:头孢曲松 4 克/24 小时和头孢唑肟 3 克/12 小时的新给药方案对接受 OPAT 的患者很方便。目的:评估头孢曲松每日一次(4 克)和头孢唑肟每 12 小时一次(3 克,每日两次)给药方案在 OPAT 环境中的耐受性、毒性和有效性:从2018年4月至2023年3月,收集了伦敦东部社区OPAT团队出院的所有成年患者的人口统计学、临床、微生物学和结果数据:共有 487 例 OPAT 病例。53名患者(10.9%)接受了头孢曲松4克/天一次,20名患者(4.1%)接受了头孢他啶3克/天两次。在头孢曲松组中,最常见的治疗病症是骨科、神经外科或糖尿病足感染。有 45 名(84.9%)患者使用 OPAT 加快了出院速度,其余患者则避免了入院。最常见的感染分离菌是 MSSA 23 种(43.4%)。没有耐受性或毒性事件的记录。在规模较小的每日两次头孢他啶治疗组中,7 名(35%)患者因坏死性中耳炎接受治疗,6 名(30%)患者因支气管扩张接受治疗,6 名(30%)患者因尿路感染接受治疗。最常见的感染原因是铜绿假单胞菌,有 18 例(90%)。有一例肾毒性记录在案。所有患者均已治愈,节省了 896 个住院日:头孢曲松每天一次,每次 4 克;头孢唑肟每天两次,每次 3 克。如果这些方案被广泛采用,将节省 OPAT 和护理时间,使更多患者得到治疗。
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CiteScore
5.30
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审稿时长
16 weeks
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