Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to <i>Enterobacter</i>, <i>Serratia</i>, and <i>Citrobacter</i> Species
Caroline Derrick,
P. Brandon Bookstaver,
Zhiqiang K. Lu,
Christopher M. Bland,
S. Travis King,
Kayla R. Stover,
Kathey Rumley,
Shawn H. MacVane,
Jenna Swindler,
Scott Kincaid,
Trisha Branan,
David Cluck,
Benjamin Britt,
Kelly E. Pillinger,
Bruce M. Jones,
Virginia Fleming,
V. Paul DiMondi,
Sandy Estrada,
Brad Crane,
Brian Odle,
Majdi N. Al-Hasan,
Julie Ann Justo
Affiliations
Caroline Derrick
Department of Medicine, University of South Carolina School of Medicine Columbia, SC 29203, USA
P. Brandon Bookstaver
Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA
Zhiqiang K. Lu
Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA
Christopher M. Bland
Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Savannah, GA 31324, USA
S. Travis King
Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS 39216, USA
Kayla R. Stover
Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS 39216, USA
Kathey Rumley
Vidant Medical Center, Greenville, NC 27835, USA
Shawn H. MacVane
Department of Pharmacy, Medical University of South Carolina, Charleston, SC 29425, USA
Jenna Swindler
McLeod Regional Medical Center, Florence, SC 29506, USA
Scott Kincaid
University of Kentucky Healthcare, Lexington, KY 40536, USA
Trisha Branan
College of Pharmacy, University of Georgia, Athens, GA 30602, USA
David Cluck
Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA
Benjamin Britt
Lexington Medical Center, West Columbia, SC 29169, USA
Kelly E. Pillinger
Carolinas HealthCare System, Charlotte, NC 28203, USA
Bruce M. Jones
St. Joseph’s/Candler Health System, Savannah, GA 31405, USA
Virginia Fleming
College of Pharmacy, University of Georgia, Athens, GA 30602, USA
V. Paul DiMondi
Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC 27506, USA
Sandy Estrada
Lee Health, Fort Myers, FL 33901, USA
Brad Crane
Blount Memorial Hospital, Maryville, TN 37804, USA
Brian Odle
Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA
Majdi N. Al-Hasan
Department of Medicine, University of South Carolina School of Medicine Columbia, SC 29203, USA
Julie Ann Justo
Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA
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.
