Short course aminoglycosides as adjunctive empiric therapy in patients with Gram-negative bloodstream infection, a cohort study.
Clin Microbiol Infect. 2020 May 05;:
Authors: Deelen JWT, Rottier WC, Buiting AGM, Dorigo-Zetsma JW, Kluytmans JAJW, van der Linden PD, Thijsen SFT, Vlaminckx BJM, Weersink AJL, Ammerlaan HSM, Bonten MJM, van Werkhoven CH
OBJECTIVE: Short-course aminoglycosides as adjunctive empirical therapy to beta-lactams in patients with a clinical suspicion of sepsis is used to broaden antibiotic susceptibility coverage and to enhance bacterial killing. We quantified the impact of this approach on 30-day mortality in a subset of sepsis patients with a Gram-negative bloodstream infection.
METHODS: From a prospective cohort study conducted in 7 hospitals in the Netherlands between June 2013 and November 2015, we selected all patients with Gram-negative bloodstream infection (GN-BSI). Short-course aminoglycoside therapy was defined as tobramycin, gentamicin or amikacin initiated within a 48-hour time window around blood culture obtainment, and prescribed for a maximum of 2 days. The outcome of interest was 30-day all-cause mortality. Confounders were selected a priori for adjustment using a propensity score analysis with inverse probability weighting.
RESULTS: 626 patients with GN-BSI who received beta-lactams were included. 156 (24.9%) also received aminoglycosides for a median of 1 day. Patients receiving aminoglycosides more often had septic shock (31/156, 19.9% vs 34/470, 7.2%) and had an 8-fold lower risk of inappropriate treatment (3/156, 1.9% vs 69/470, 14.7%). Thirty-day mortality was 17.3% (27/156) and 13.6% (64/470) for patients receiving and not receiving aminoglycosides, yielding a crude and adjusted odds ratio for 30-day mortality for patients treated with aminoglycosides of 1.33 (95% CI 0.80 - 2.15), and 1.57 (0.84 - 2.93), respectively.
CONCLUSIONS: Short-course adjunctive aminoglycoside treatment as part of empiric therapy with beta-lactam antibiotics in patients with GN-BSI did not result in improved outcomes, despite better antibiotic coverage of pathogens.
PMID: 32387438 [PubMed - as supplied by publisher]