无并发症链球菌菌血症的抗菌治疗时间:时间越短越好的另一个例子

IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Journal of Infection Pub Date : 2024-10-13 DOI:10.1016/j.jinf.2024.106313
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引用次数: 0

摘要

目的:无并发症链球菌菌血症的治疗时间尚不清楚。本研究旨在评估接受短疗程(5-10 天)抗菌药物治疗的无并发症链球菌菌血症患者与接受传统长疗程(11-18 天)抗菌药物治疗的患者的临床疗效。临床失败定义为死亡、同一链球菌菌血症复发以及在120天内出现骨关节感染。抗菌治疗的中位持续时间为 10 天(四分位数间距:7-14 天);分别有 184 例(55%)和 152 例(45%)患者接受了短期(5-10 天)和长期(11-18 天)抗菌治疗。43例(13%)临床治疗失败;120天死亡率为11%(36例);8例(2%)再次发生同一链球菌菌血症。接受短疗程和长疗程抗菌治疗的病例在临床失败率上没有差异(10% 对 16%;P 0.143)。Cox多变量回归模型发现,Charlson合并症指数>4(aHR 4.87,95% CI 3.08-7.71)和脓毒性休克(1.67,1.04-2.67)与临床失败有关;抗菌治疗疗程短与临床失败无关(0.90,0.57-1.12)。
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Duration of antimicrobial treatment for uncomplicated streptococcal bacteraemia: Another example of shorter is better

Objectives

Duration of treatment for uncomplicated streptococcal bacteraemia is unknown. The study aims to assess clinical outcomes of patients with uncomplicated streptococcal bacteraemia receiving a short course (5–10 days) of antimicrobial treatment compared to those receiving the traditional, longer duration (11–18 days).

Methods

This retrospective study was conducted at the Lausanne University Hospital, Switzerland and included episodes of uncomplicated streptococcal bacteraemia among adult patients from 2015 to 2023. Clinical failure was defined as mortality, recurrence of bacteraemia by the same streptococcal species and development in bone and joint infection within 120 days.

Results

During the study period, 336 episodes of uncomplicated streptococcal bacteraemia were included. The median duration of antimicrobial treatment was 10 days (interquartile range: 7–14); 184 (55%) and 152 (45%) episodes received a short (5–10 days) and long (11–18 days) duration of antimicrobial treatment, respectively. Forty-three (13%) episodes had clinical failure; 120-day mortality was 11% (36 episodes); recurrence of bacteraemia by the same streptococcal species was observed in 8 episodes (2%). No difference in clinical failure was observed between episodes receiving short and long courses of antimicrobial treatment (10% versus 16%; P 0.143). The Cox multivariable regression model found that a Charlson comorbidity index >4 (aHR 4.87, 95% CI 3.08–7.71), and septic shock (1.67, 1.04–2.67) were associated with clinical failure; a short course of antimicrobial treatment was not associated with clinical failure (0.90, 0.57–1.12).

Conclusions

This study has shown that a short duration of antimicrobial treatment for cases of streptococcal bacteraemia is effective and safe.
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来源期刊
Journal of Infection
Journal of Infection 医学-传染病学
CiteScore
45.90
自引率
3.20%
发文量
475
审稿时长
16 days
期刊介绍: The Journal of Infection publishes original papers on all aspects of infection - clinical, microbiological and epidemiological. The Journal seeks to bring together knowledge from all specialties involved in infection research and clinical practice, and present the best work in the ever-changing field of infection. Each issue brings you Editorials that describe current or controversial topics of interest, high quality Reviews to keep you in touch with the latest developments in specific fields of interest, an Epidemiology section reporting studies in the hospital and the general community, and a lively correspondence section.
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