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Shalabi O, Kashat L, Murik O, Zevin S, Assous MV, Ben-Chetrit E. Clinical Outcomes of Patients with AmpC-Beta-Lactamase-Producing Enterobacterales Bacteremia Treated with Carbapenems versus Non-Carbapenem Regimens: A Single-Center Study. Antibiotics (Basel) 2024; 13:709. [PMID: 39200009 PMCID: PMC11350690 DOI: 10.3390/antibiotics13080709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/14/2024] [Accepted: 07/26/2024] [Indexed: 09/01/2024] Open
Abstract
INTRODUCTION Bloodstream infections caused by AmpC-producing Enterobacterales pose treatment challenges due to the risk of AmpC overproduction and treatment failure. Current guidelines recommend carbapenems or cefepime as optimal therapy. We aimed to evaluate empiric and definitive non-carbapenem regimens for these infections. METHODS In a retrospective study from June 2014 to March 2023, adult bacteremic patients with Enterobacter cloacae complex strains and Morganella morganii were evaluated. Demographic, clinical and lab data and outcomes were assessed. RESULTS The cohort comprised 120 bacteremic patients, 17 receiving empiric carbapenem and 103 non-carbapenem regimens. Both groups had similar Charlson and Norton scores and previous antimicrobial exposure. The most common sources of bacteremia were urinary, abdominal and central-line-associated sources. Empiric non-carbapenem regimens (primarily piperacillin-tazobactam and cephalosporins) were not associated with recurrent bacteremia or 30-day mortality. Definitive regimens included mainly carbapenems (n = 41) and ciprofloxacin (n = 46). Beta-lactams were administered to 25 patients. Recurrent bacteremia and 30-day mortality rates were similar among treatment groups. Ciprofloxacin showed comparable outcomes to carbapenems, however, severity of illness among these patients was lower. CONCLUSIONS Empiric and definitive non-carbapenem regimens for bacteremia with AmpC-producing organisms were not associated with treatment failure or increased 30-day mortality. Ciprofloxacin appears promising for selected, stable patients, potentially enabling early discharge.
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Affiliation(s)
- Orjowan Shalabi
- Medical Department B, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Hadassah Medical School, Hebrew University, Jerusalem 91904, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 91904, Israel
| | - Livnat Kashat
- Faculty of Medicine, Hebrew University, Jerusalem 91904, Israel
- Clinical Microbiology Lab, Shaare Zedek Medical Center, Hadassah Medical School, Hebrew University, Jerusalem 91904, Israel
| | - Omer Murik
- Faculty of Medicine, Hebrew University, Jerusalem 91904, Israel
- Translational Genomics Lab, Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem 91904, Israel
| | - Shoshana Zevin
- Medical Department B, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Hadassah Medical School, Hebrew University, Jerusalem 91904, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 91904, Israel
| | - Marc V. Assous
- Faculty of Medicine, Hebrew University, Jerusalem 91904, Israel
- Clinical Microbiology Lab, Shaare Zedek Medical Center, Hadassah Medical School, Hebrew University, Jerusalem 91904, Israel
| | - Eli Ben-Chetrit
- Faculty of Medicine, Hebrew University, Jerusalem 91904, Israel
- Infectious Diseases Unit, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Hadassah Medical School, Hebrew University, Jerusalem 91904, Israel
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