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Clinical Benefit of Appropriate Empirical Fluoroquinolone Therapy for Adults with Community-onset Bacteremia in Comparison with Third-generation Cephalosporin Therapy.
Antimicrob Agents Chemother. 2016 Nov 14;:
Authors: Lee CC, Wang JL, Lee CH, Hsieh CC, Hung YP, Hong MY, Tang HJ, Ko WC
Abstract
Both fluoroquinolones (FQs) and third-generation cephalosporins (3(rd)-GCs) are commonly prescribed to treat bloodstream infections, but comparative efficacies between them were rarely studied. Demographics and clinical characteristics of 733 adults with polymicrobial or monomicrobial community-onset bacteremia empirically treated by an appropriate FQ (n = 87) or 3(rd)-GC (n = 646) were compared. A critical illness (8.0% vs. 19.0%, P = 0.01), an initial syndrome with severe sepsis (33.3% vs. 50.3%, P = 0.003), or a fatal outcome at 28 days (4.6% vs. 10.5%, P = 0.08) was less common in the FQ group. Of them, 645 (88.0%) patients were febrile at initial presentation and the FQ group with (7.6 days vs. 12.0 days, P = 0.04) and without (3.8 days vs. 5.4 days, P = 0.001) a critical illness had shorter time to defervescence than the 3(rd)-GC group. By the propensity scores, 87 patients with appropriate FQ therapy were matched with 435 treated by 3(rd)-GC therapy at a ratio of 1:5, and there were no significant differences in terms of bacteremia severity, comorbidity severity, major comorbidities, causative microorganisms, and bacteremia sources between groups. Moreover, crude mortality rates at 28 days (4.6% vs. 7.8%, P = 0.29) did not differ significantly. However, the time to defervescence was shorter in the FQ group (4.2 ± 3.6 vs. 6.2 ± 7.6 days, P < 0.001). Conclusively in the adults with community-onset bacteremia, appropriate empirical FQ therapy was related to shorter time to defervescence than 3(rd)-GC therapy, at least for those without a critical illness.
PMID: 27855072 [PubMed - as supplied by publisher]