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Open AccessArticle

Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species

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Department of Medicine, University of South Carolina School of Medicine Columbia, SC 29203, USA
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Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA
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Prisma Health Richland, Columbia, SC 29203, USA
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Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Savannah, GA 31324, USA
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St. Joseph’s/Candler Health System, Savannah, GA 31405, USA
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Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS 39216, USA
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Vidant Medical Center, Greenville, NC 27835, USA
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Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC 27506, USA
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Department of Pharmacy, Medical University of South Carolina, Charleston, SC 29425, USA
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McLeod Regional Medical Center, Florence, SC 29506, USA
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University of Kentucky Healthcare, Lexington, KY 40536, USA
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College of Pharmacy, University of Georgia, Athens, GA 30602, USA
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Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA
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Lexington Medical Center, West Columbia, SC 29169, USA
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Carolinas HealthCare System, Charlotte, NC 28203, USA
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WakeMed Health and Hospitals, Raleigh, NC 27610, USA
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Lee Health, Fort Myers, FL 33901, USA
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Blount Memorial Hospital, Maryville, TN 37804, USA
*
Author to whom correspondence should be addressed.
Present address: S. Travis King, Ochsner Medical Center, New Orleans, LA 70121, USA; Shawn H. MacVane, Accelerate Diagnostics, Tucson, AZ 85719, USA; Kelly E. Pillinger, University of Rochester Medical Center, Rochester, NY 14642, USA; V. Paul DiMondi, Janssen Pharmaceutical Companies of Johnson and Johnson, Titusville, NJ 08560, USA; Sandy Estrada, T2 Biosystems, Lexington, MA 02421, USA.
Received: 16 April 2020 / Revised: 9 May 2020 / Accepted: 12 May 2020 / Published: 14 May 2020
(This article belongs to the Special Issue Gram-Negative Bloodstream Infections)
Objectives: There is debate on whether the use of third-generation cephalosporins (3GC) increases the risk of clinical failure in bloodstream infections (BSIs) caused by chromosomally-mediated AmpC-producing Enterobacterales (CAE). This study evaluates the impact of definitive 3GC therapy versus other antibiotics on clinical outcomes in BSIs due to Enterobacter, Serratia, or Citrobacter species. Methods: This multicenter, retrospective cohort study evaluated adult hospitalized patients with BSIs secondary to Enterobacter, Serratia, or Citrobacter species from 1 January 2006 to 1 September 2014. Definitive 3GC therapy was compared to definitive therapy with other non-3GC antibiotics. Multivariable Cox proportional hazards regression evaluated the impact of definitive 3GC on overall treatment failure (OTF) as a composite of in-hospital mortality, 30-day hospital readmission, or 90-day reinfection. Results: A total of 381 patients from 18 institutions in the southeastern United States were enrolled. Common sources of BSIs were the urinary tract and central venous catheters (78 (20.5%) patients each). Definitive 3GC therapy was utilized in 65 (17.1%) patients. OTF occurred in 22/65 patients (33.9%) in the definitive 3GC group vs. 94/316 (29.8%) in the non-3GC group (p = 0.51). Individual components of OTF were comparable between groups. Risk of OTF was comparable with definitive 3GC therapy vs. definitive non-3GC therapy (aHR 0.93, 95% CI 0.51–1.72) in multivariable Cox proportional hazards regression analysis. Conclusions: These outcomes suggest definitive 3GC therapy does not significantly alter the risk of poor clinical outcomes in the treatment of BSIs secondary to Enterobacter, Serratia, or Citrobacter species compared to other antimicrobial agents. View Full-Text
Keywords: bacteremia; cephalosporins; sepsis; beta-lactamases; AmpC; carbapenems bacteremia; cephalosporins; sepsis; beta-lactamases; AmpC; carbapenems
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Figure 1

MDPI and ACS Style

Derrick, C.; Bookstaver, P.B.; Lu, Z.K.; Bland, C.M.; King, S.T.; Stover, K.R.; Rumley, K.; MacVane, S.H.; Swindler, J.; Kincaid, S.; Branan, T.; Cluck, D.; Britt, B.; Pillinger, K.E.; Jones, B.M.; Fleming, V.; DiMondi, V.P.; Estrada, S.; Crane, B.; Odle, B.; Al-Hasan, M.N.; Justo, J.A., on behalf of the SERGE-45 Investigators. Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species. Antibiotics 2020, 9, 254. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9050254

AMA Style

Derrick C, Bookstaver PB, Lu ZK, Bland CM, King ST, Stover KR, Rumley K, MacVane SH, Swindler J, Kincaid S, Branan T, Cluck D, Britt B, Pillinger KE, Jones BM, Fleming V, DiMondi VP, Estrada S, Crane B, Odle B, Al-Hasan MN, Justo JA on behalf of the SERGE-45 Investigators. Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species. Antibiotics. 2020; 9(5):254. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9050254

Chicago/Turabian Style

Derrick, Caroline; Bookstaver, P. B.; Lu, Zhiqiang K.; Bland, Christopher M.; King, S. T.; Stover, Kayla R.; Rumley, Kathey; MacVane, Shawn H.; Swindler, Jenna; Kincaid, Scott; Branan, Trisha; Cluck, David; Britt, Benjamin; Pillinger, Kelly E.; Jones, Bruce M.; Fleming, Virginia; DiMondi, V. P.; Estrada, Sandy; Crane, Brad; Odle, Brian; Al-Hasan, Majdi N.; Justo, Julie A. on behalf of the SERGE-45 Investigators 2020. "Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species" Antibiotics 9, no. 5: 254. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9050254

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