Bartoletti, Michele ORCID: 0000-0002-1099-3283, Giannella, Maddalena, Lewis, Russell E., Caraceni, Paolo, Tedeschi, Sara, Paul, Mical, Schramm, Christoph, Bruns, Tony ORCID: 0000-0002-5576-6914, Merli, Manuela, Cobos-Trigueros, Nazaret, Seminari, Elena, Retamar, Pilar, Munoz, Patricia, Tumbarello, Mario, Burra, Patrizia, Cerenzia, Maria Torrani, Barsic, Bruno, Calbo, Ester, Maraolo, Alberto Enrico, Petrosillo, Nicola, Galan-Ladero, Maria Angeles, D'Offizi, Gianpiero, Zak-Doron, Yael, Rodriguez-Bano, Jesus ORCID: 0000-0001-6732-9001, Baldassarre, Maurizio, Verucchi, Gabriella, Domenicali, Marco, Bernardi, Mauro, Viale, Pierluigi, Campoli, Caterina, Pascale, Renato, Stallmach, Andreas, Venditti, Mario, Lucidi, Cristina, Ludovisi, Serena, de Cueto, Marina, Maria Dolores, Navarro, Cortes Eduardo, Lopez, Bouza, Emilo, Valerio, Maricela, Eworo, Alia, Losito, Raffaella, Senzolo, Marco, Nadal, Elena, Ottobrelli, Antonio, Varguvic, Martina, Badia, Cristina, Guglielmo, Borgia, Gentile, Ivan, Buonomo, Antonio Riccardo, Boumis, Evangelo, Beteta-Lopez, Alicia, Rianda, Alessia, Taliani, Gloria and Grieco, Stefania (2019). Extended Infusion of beta-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis: An Observational Multicenter Study. Clin. Infect. Dis., 69 (10). S. 1731 - 1740. CARY: OXFORD UNIV PRESS INC. ISSN 1537-6591

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Abstract

Background. We analyzed the impact of continuous/extended infusion (C/EI) vs intermittent infusion of piperacillin-tazobactam (TZP) and carbapenems on 30-day mortality of patients with liver cirrhosis and bloodstream infection (BSI). Methods. The BICRHOME study was a prospective, multicenter study that enrolled 312 cirrhotic patients with BSI. In this secondary analysis, we selected patients receiving TZP or carbapenems as adequate empirical treatment. The 30-day mortality of patients receiving C/EI or intermittent infusion of TZP or carbapenems was assessed with Kaplan-Meier curves, Cox-regression model, and estimation of the average treatment effect (ATE) using propensity score matching. Results. Overall, 119 patients received TZP or carbapenems as empirical treatment. Patients who received C/EI had a significantly lower mortality rate (16% vs 36%, P = .047). In a Cox-regression model, the administration of C/EI was associated with a significantly lower mortality (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.11-0.936; P = .04) when adjusted for severity of illness and an ATE of 25.6% reduction in 30-day mortality risk (95% CI, 18.9-32.3; P < .0001) estimated with propensity score matching. A significant reduction in 30-day mortality was also observed in the subgroups of patients with sepsis (HR, 0.21; 95% CI, 0.06-0.74), acute-on-chronic liver failure (HR, 0.29; 95% CI, 0.03-0.99), and a model for end-stage liver disease score >= 25 (HR, 0.26; 95% CI, 0.08-0.92). At competing risk analysis, C/EI of beta-lactams was associated with significantly higher rates of hospital discharge (subdistribution hazard [95% CI], 1.62 [1.06-2.47]). Conclusions. C/EI of beta-lactams in cirrhotic patients with BSI may improve outcomes and facilitate earlier discharge.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Bartoletti, MicheleUNSPECIFIEDorcid.org/0000-0002-1099-3283UNSPECIFIED
Giannella, MaddalenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lewis, Russell E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Caraceni, PaoloUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tedeschi, SaraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Paul, MicalUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schramm, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bruns, TonyUNSPECIFIEDorcid.org/0000-0002-5576-6914UNSPECIFIED
Merli, ManuelaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cobos-Trigueros, NazaretUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Seminari, ElenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Retamar, PilarUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Munoz, PatriciaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tumbarello, MarioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Burra, PatriziaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cerenzia, Maria TorraniUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Barsic, BrunoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Calbo, EsterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Maraolo, Alberto EnricoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Petrosillo, NicolaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Galan-Ladero, Maria AngelesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
D'Offizi, GianpieroUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zak-Doron, YaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rodriguez-Bano, JesusUNSPECIFIEDorcid.org/0000-0001-6732-9001UNSPECIFIED
Baldassarre, MaurizioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Verucchi, GabriellaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Domenicali, MarcoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bernardi, MauroUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Viale, PierluigiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Campoli, CaterinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pascale, RenatoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stallmach, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Venditti, MarioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lucidi, CristinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ludovisi, SerenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
de Cueto, MarinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Maria Dolores, NavarroUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cortes Eduardo, LopezUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bouza, EmiloUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Valerio, MaricelaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Eworo, AliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Losito, RaffaellaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Senzolo, MarcoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nadal, ElenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ottobrelli, AntonioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Varguvic, MartinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Badia, CristinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guglielmo, BorgiaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gentile, IvanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Buonomo, Antonio RiccardoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boumis, EvangeloUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Beteta-Lopez, AliciaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rianda, AlessiaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Taliani, GloriaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Grieco, StefaniaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-127500
DOI: 10.1093/cid/ciz032
Journal or Publication Title: Clin. Infect. Dis.
Volume: 69
Number: 10
Page Range: S. 1731 - 1740
Date: 2019
Publisher: OXFORD UNIV PRESS INC
Place of Publication: CARY
ISSN: 1537-6591
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
SPONTANEOUS BACTERIAL PERITONITIS; CLINICAL-FEATURES; SEVERE SEPSIS; ANTIBIOTICS; EPIDEMIOLOGY; CHALLENGES; RESISTANCE; MORTALITY; THERAPY; IMPACTMultiple languages
Immunology; Infectious Diseases; MicrobiologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/12750

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