Impact of cefepime therapy on mortality among patients with blood stream infections caused by extended spectrum ?-lactamase-producing Klebsiella pneumoniae and Escherichia coli.
Antimicrob Agents Chemother. 2012 Apr 30;
Authors: Chopra T, Marchaim D, Veltman J, Johnson P, Zhao JJ, Tansek R, Hatahet D, Chaudhry K, Pogue JM, Rahbar H, Chen TY, Truong T, Rodriguez V, Ellsworth J, Bernabela L, Bhargava A, Yousuf A, Alangaden G, Kaye KS
Abstract
Background: Extended-spectrum beta lactamase (ESBL)-producing pathogens are associated with extensive morbidity, mortality, and rising healthcare costs. Scant data exist on the impact of antimicrobial therapy on clinical outcomes in patients with ESBL bloodstream infections (BSI) and no large studies have examined the impact of cefepime therapy. Methods: A retrospective 3 year study was performed at the Detroit Medical Center on adult patients with ESBL-producing K. pneumoniae or E. coli BSI. Data were collected from the medical records of study patients at five hospitals between January 2005 and December 2007. Multivariate analysis was performed using logistic regression. Results: One-hundred and forty-five patients with BSI due to ESBL-producing pathogens were studied, including K. pneumoniae (83%), and E. coli(16.5%). The mean age of the patients was 66 years, 51% were female and 79.3% were African-American. 53 patients (37%) died in the hospital and 92 survived to discharge. In bivariate analysis, the following variables were associated with mortality (p<0.05): presence of a rapidly fatal condition at the time of admission, use of gentamicin as a consolidative therapeutic agent, and presence of one or more of the following prior to culture date: mechanical ventilation, stay in the intensive care unit (ICU), and presence of a central venous catheter. In multivariate analysis, the predictors of in-hospital mortality included: intensive care unit stay (OR=2.17, 95% CI 0.98-4.78), presence of a central line prior to positive culture (OR=2.33, 95%CI 0.77-7.03) presence of a rapidly fatal condition at the time of admission (OR=5.13,95%CI 2.13-12.39) and recent prior hospitalization (OR=1.92,95%CI 0.83-4.09). When carbapenems were added as empiric therapy to the predictor model, there was a trend between empiric carbapenem therapy and decreased mortality (OR=0.61,95% CI 0.26-1.50). When added to the model, receipt of empiric cefepime alone (n=43) was associated with increased mortality, although this association did not reach statistical significance (OR= 1.66, 95% CI 0.71-3.87). Median length of hospital stay was shorter for patients receiving empiric cefepime and longer for those receiving empiric or consolidated carbapenem therapy. Conclusions: In multivariate analysis, empiric therapy with cefepime for BSI due to an ESBL-producing pathogen was associated with a trend towards an increased mortality risk and empiric carbapenem therapy was associated with a trend towards decreased mortality risk.
PMID: 22547616 [PubMed - as supplied by publisher]