Abstract
Objectives: Chromosomally mediated AmpC-producing Enterobacteriaceae (CAE) display high susceptibility to fluoroquinolones; minimal clinical data exist supporting comparative clinical outcomes. The objective of this study was to compare treatment outcomes between fluoroquinolone and nonfluoroquinolone definitive therapy of bloodstream infections caused by CAE. Methods: This retrospective cohort assessed adult patients with positive blood cultures for CAE that received inpatient treatment for ≥48 h. The primary outcome was difference in clinical failure between patients who received fluoroquinolone (FQ) versus non-FQ treatment. Secondary endpoints included microbiological cure, infection-related length of stay, 90-day readmission, and all-cause inpatient mortality. Results: 56 patients were included in the study (31 (55%) received a FQ as definitive therapy; 25 (45%) received non-FQ). All non-FQ patients received a beta-lactam (BL). Clinical failure occurred in 10 (18%) patients, with 4 (13%) in the FQ group and 6 (24%) in the BL group (p = 0.315). Microbiological cure occurred in 55 (98%) patients. Median infection-related length of stay was 10 (6–20) days, with a significantly longer stay occurring in the BL group (p = 0.002). There was no statistical difference in 90-day readmissions between groups (7% FQ vs. 17% BL; p = 0.387); one patient expired. Conclusion: These results suggest that fluoroquinolones do not adversely impact clinical outcomes in patients with CAE. When alternatives to beta-lactam therapy are needed, fluoroquinolones may provide an effective option.
Highlights
Gram-negative infections, bloodstream infections, cause a high incidence of morbidity and mortality [1,2,3,4]
Several studies have evaluated the impact of gram negative bacteria on clinical patient outcomes, in patients with elevated minimum inhibitory concentrations (MICs) to traditionally used antimicrobials [7,8,9,10,11,12]
A total of 56 patients were included in the study, where 31 (55%) patients received a fluoroquinolone (FQ) as definitive therapy, and 25 (45%)
Summary
Gram-negative infections, bloodstream infections, cause a high incidence of morbidity and mortality [1,2,3,4]. Several studies have evaluated the impact of gram negative bacteria on clinical patient outcomes, in patients with elevated minimum inhibitory concentrations (MICs) to traditionally used antimicrobials [7,8,9,10,11,12]. Threats in the United States, Enterobacteriaceae represent urgent (carbapenem-resistant) and serious (extended-spectrum beta-lactamase-producing) threats [13]. AmpC-producing Enterobacteriaceae (CAE) are a group of bacteria that harbor inducible resistance to penicillins and first- through third-generation cephalosporins [14]. AmpC beta-lactamases are known to inactivate cefoxitin, as well as other cephalosporins, allowing clinicians an easy way to quickly identify a possible AmpC producer without running a genotypic test [15,16]. Cefoxitin resistance has a sensitivity and specificity of 97.4% and 78.7%, respectively, at identifying an AmpC-producing organism [16]. Many clinicians rely on this to provide insight as to the appropriate definitive coverage needed for these organisms
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