Clinical Impact of Ceftriaxone Resistance in Escherichia coli Bloodstream Infections: A Multicenter Prospective Cohort Study

Ceftriaxone-resistant (CRO-R) bloodstream infections (BSIs) are common. This is a prospective cohort of patients with BSI at 14 United States hospitals between November 2020 and April 2021. For each patient with a CRO-R BSI enrolled, the next consecutive patient with a ceftriaxone-susceptible (CRO-S...

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Published in:Open forum infectious diseases 2022-11, Vol.9 (11), p.ofac572-ofac572
Main Authors: Tamma, Pranita D, Komarow, Lauren, Ge, Lizhao, Garcia-Diaz, Julia, Herc, Erica S, Doi, Yohei, Arias, Cesar A, Albin, Owen, Saade, Elie, Miller, Loren G, Jacob, Jesse T, Satlin, Michael J, Krsak, Martin, Huskins, W Charles, Dhar, Sorabh, Shelburne, Samuel A, Hill, Carol, Baum, Keri R, Bhojani, Minal, Greenwood-Quaintance, Kerryl E, Schmidt-Malan, Suzannah M, Patel, Robin, Evans, Scott R, Chambers, Henry F, Fowler, Jr, Vance G, van Duin, David
Format: Article
Language:English
Subjects:
Beta lactamases
Ceftriaxone
Ceftriaxone sodium
Escherichia coli
Health aspects
Infection
Long-term care of the sick
Major
Medical research
Medicine, Experimental
Methylene blue
Michigan
Mortality
North Carolina
Pharmaceutical industry
Tazobactam
United States
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Summary:Ceftriaxone-resistant (CRO-R) bloodstream infections (BSIs) are common. This is a prospective cohort of patients with BSI at 14 United States hospitals between November 2020 and April 2021. For each patient with a CRO-R BSI enrolled, the next consecutive patient with a ceftriaxone-susceptible (CRO-S) BSI was included. Primary outcome was desirability of outcome ranking (DOOR) at day 30, with 50% probability of worse outcomes in the CRO-R group as the null hypothesis. Inverse probability weighting (IPW) was used to reduce confounding. Notable differences between patients infected with CRO-R and CRO-S BSI included the proportion with Pitt bacteremia score ≥4 (23% vs 15%, = .079) and the median time to active antibiotic therapy (12 hours [interquartile range {IQR}, 1-35 hours] vs 1 hour [IQR, 0-6 hours]; < .001). Unadjusted DOOR analyses indicated a 58% probability (95% confidence interval [CI], 52%-63%) for a worse clinical outcome in CRO-R versus CRO-S BSI. In the IPW-adjusted cohort, no difference was observed (54% [95% CI, 47%-61%]). Secondary outcomes included unadjusted and adjusted differences in the proportion of 30-day mortality between CRO-R and CRO-S BSIs (-5.3% [95% CI, -10.3% to -.4%] and -1.8 [95% CI, -6.7% to 3.2%], respectively), postculture median length of stay (8 days [IQR, 5-13 days] vs 6 days [IQR, 4-9 days]; < .001), and incident admission to a long-term care facility (22% vs 12%, = .045). Patients with CRO-R BSI generally have poorer outcomes compared to patients infected with CRO-S BSI, even after adjusting for important confounders.
ISSN:2328-8957
2328-8957
DOI:10.1093/ofid/ofac572