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- Title
Extended Infusion of β-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis: An Observational Multicenter Study.
- Authors
Bartoletti, Michele; Giannella, Maddalena; Lewis, Russell E; Caraceni, Paolo; Tedeschi, Sara; Paul, Mical; Schramm, Christoph; Bruns, Tony; Merli, Manuela; Cobos-Trigueros, Nazaret; Seminari, Elena; Retamar, Pilar; Muñoz, Patricia; Tumbarello, Mario; Burra, Patrizia; Cerenzia, Maria Torrani; Barsic, Bruno; Calbo, Ester; Maraolo, Alberto Enrico; Petrosillo, Nicola
- 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.
- Subjects
MORTALITY risk factors; BACTEREMIA; COMBINATION drug therapy; CONFIDENCE intervals; INFUSION therapy equipment; CIRRHOSIS of the liver; LIVER diseases; LIVER failure; LONGITUDINAL method; PENICILLIN; MEDICAL cooperation; SCIENTIFIC observation; PROBABILITY theory; RESEARCH; RISK assessment; SEPSIS; SECONDARY analysis; DISCHARGE planning; TREATMENT effectiveness; PROPORTIONAL hazards models; SEVERITY of illness index; CARBAPENEMS; AMPICILLIN; KAPLAN-Meier estimator; ODDS ratio; DISEASE complications
- Publication
Clinical Infectious Diseases, 2019, Vol 69, Issue 10, p1731
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciz032