替莫西林治疗由产 ESBL 肠杆菌引起的非尿路感染的疗效及失败的风险因素。

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-10-17 eCollection Date: 2024-10-01 DOI:10.1093/jacamr/dlae164
Christel Mamona Kilu, Camille Menvielle, Anne Cataldi, Antoine Hamon, Clara Duran, Cedric Mwanba, Chloé Tesmoingt, Laura Bouabdallah-Perrin, Pauline Touche, Aurélie Chanh Hew Wai, Clément Ourghanlian, Marie Antignac, Marc-Antoine Bildan, Alexandre Bleibtreu, Hugues Michelon, Sylvain Diamantis, Benoit Pilmis, Antoine Citerne, Eric Farfour, Aurélien Dinh
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引用次数: 0

摘要

目的描述替莫西林治疗非尿路感染的实际使用情况,评估其对产ESBL肠杆菌感染的疗效,并确定治疗失败的风险因素:方法:在14家三级医院开展回顾性多中心研究,包括2016年1月1日至2021年12月31日期间因非泌尿道感染接受至少一剂替莫西林治疗的所有ESBL感染患者。在28天的随访中,感染症状持续或再次出现,和/或转为抑制性抗生素治疗和/或因感染死亡,即为失败的综合标准。通过单变量和多变量分析进行逻辑回归,以确定与失败相关的风险:共收集到 163 例感染的数据,其中 133 例为产 ESBL 肠杆菌感染,128 例纳入有效性分析。中位(IQR)年龄为 61(53-70)岁,61.7% 的患者为男性。主要适应症为下呼吸道感染(LRTI,28.9%)、腹腔内感染(IAI,28.1%)和皮肤感染(12.5%)。涉及的主要细菌为肺炎克雷伯菌(48.4%)、大肠埃希菌(25.0%)和泄殖腔肠杆菌(24.2%)。45.3%的病例发生了多菌感染。有 86/128 例(67.2%)患者使用了替莫西林作为单一疗法。36/128(28.1%)例患者治疗失败。在多变量分析中,与治疗失败相关的唯一因素是最初发病的严重程度[调整后 OR 3.0 (95% CI: 1.06-8.69)]:结论:在非尿路感染期间,替莫西林主要用于产ESBL大肠杆菌和肺炎双球菌引起的LRTI和IAI。失败的主要风险因素是最初疾病的严重程度。
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Effectiveness of temocillin in treatment of non-urinary tract infections caused by ESBL-producing Enterobacterales and risk factors for failure.

Objectives: To describe the real-life use of temocillin for non-urinary tract infections, to assess its effectiveness in infections caused by ESBL-producing Enterobacterales, and to identify risk factors for treatment failure.

Method: Retrospective multicentric study in 14 tertiary care hospitals, including all patients who received at least one dose of temocillin for ESBL infections from 1 January 2016 to 31 December 2021 for non-urinary tract infections. Failure was a composite criterion defined within 28 day follow-up by persistence or reappearance of signs of infection, and/or switch to suppressive antibiotic treatment and/or death from infection. Logistic regression with univariable and multivariable analysis was performed to identify risks associated with failure.

Results: Data on 163 infection episodes were collected; 133 were due to ESBL-producing Enterobacterales and 128 were included in the effectiveness analysis. Median (IQR) age was 61 (53-70) years and 61.7% of patients were male. Main indications were lower respiratory tract infection (LRTI; 28.9%), intra-abdominal infections (IAI; 28.1%) and cutaneous infections (12.5%). The main bacteria involved were Klebsiella pneumoniae (48.4%), Escherichia coli (25.0%) and Enterobacter cloacae (24.2%). Polymicrobial infections occurred in 45.3% of cases. Temocillin was used as monotherapy in 86/128 (67.2%). Failure was found in 36/128 (28.1%) cases. In multivariable analysis, the only factor associated with failure was initial severity of the episode [adjusted OR 3.0 (95% CI: 1.06-8.69)].

Conclusions: During non-urinary tract infections, the main use of temocillin was for LRTIs and IAIs due to ESBL-producing E. coli and K. pneumoniae. The main risk factor for failure was initial severity of the disease.

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