کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
8964071 | 1646644 | 2018 | 27 صفحه PDF | دانلود رایگان |
عنوان انگلیسی مقاله ISI
Evaluation of a risk-guided strategy for empirical carbapenem use in febrile neutropenia
ترجمه فارسی عنوان
ارزیابی یک استراتژی هدایت شده توسط ریسک برای استفاده تجربی کرباپنم در نوتروپنی تب
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کلمات کلیدی
موضوعات مرتبط
علوم زیستی و بیوفناوری
ایمنی شناسی و میکروب شناسی
میکروبیولوژی و بیوتکنولوژی کاربردی
چکیده انگلیسی
Febrile neutropenia (FN) is associated with substantial morbidity and necessitates empirical broad-spectrum antimicrobial treatment. In this prospective cohort study, a risk-guided management strategy for FN using empirical piperacillin/tazobactam (TZP) or a carbapenem was evaluated. The analysis involved 723 FN episodes in hospitalised adult patients, including those with severe sepsis or prior infection/colonisation with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Propensity score matching analysis was used to adjust for baseline differences between treatment groups and produced 267 matched pairs. The primary outcome was all-cause mortality. Secondary outcomes were the incidences of drug-resistant Gram-negative (including ESBL-producing) and Gram-positive bacterial isolates and of invasive pulmonary aspergillosis (IPA) and their associated mortality. There was no difference in mortality between empirical carbapenem and TZP [18/267 (6.7%) vs. 14/267 (5.2%); Pâ¯=â¯0.466]. Higher incidences of drug-resistant Gram-negative isolates [77/267 (28.8%) vs. 26/267 (9.7%); P < 0.001], including ESBL-producing bacteria [57/267 (21.3%) vs. 16/267 (6.0%); P < 0.001], were observed in carbapenem-treated episodes where its use lowered mortality. Mortality rates for ESBL-positive infections were 5.3% (3/57) and 25.0% (4/16) (Pâ¯=â¯0.037) and for drug-resistant Gram-negative infections were 6.5% (5/77) and 23.1% (6/26) (Pâ¯=â¯0.018) in carbapenem- and TZP-treated episodes, respectively. More IPA was observed with carbapenem use [16/267 (6.0%) vs. 6/267 (2.2%); Pâ¯=â¯0.029]. Antifungal prophylaxis reduced the risk of death (odds ratioâ¯=â¯0.39, 95% confidence interval 0.17-0.87; Pâ¯=â¯0.017). Risk-guided carbapenem prescribing in FN correctly identified cases prone to drug-resistant Gram-negative infections and reduced the mortality in these episodes.
ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: International Journal of Antimicrobial Agents - Volume 52, Issue 3, September 2018, Pages 350-357
Journal: International Journal of Antimicrobial Agents - Volume 52, Issue 3, September 2018, Pages 350-357
نویسندگان
Ai Leng Khoo, Ying Jiao Zhao, Monica Teng, Ding Ying, Jing Jin, Yen Lin Chee, Li Mei Poon, Siew Eng Lim, Liang Piu Koh, Wee Joo Chng, Boon Peng Lim, Li Yang Hsu, Louis Yi Ann Chai,