{"id":27211,"date":"2025-01-23T04:15:00","date_gmt":"2025-01-22T20:15:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=27211"},"modified":"2025-01-23T07:11:30","modified_gmt":"2025-01-22T23:11:30","slug":"clin-infect-dis%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e9%80%9a%e8%bf%87beta%e5%86%85%e9%85%b0%e8%83%ba%e6%8a%97%e7%94%9f%e7%b4%a0%e9%99%8d%e9%98%b6%e6%a2%af%e6%b2%bb%e7%96%97%e9%a2%84","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=27211","title":{"rendered":"[Clin Infect Dis\u53d1\u8868\u8bba\u6587]\uff1a\u901a\u8fc7beta\u5185\u9170\u80fa\u6297\u751f\u7d20\u964d\u9636\u68af\u6cbb\u7597\u9884\u9632\u8113\u6bd2\u75c7\u60a3\u8005\u51fa\u73b0\u65b0\u7684\u9769\u5170\u9634\u6027\u83cc\u8010\u836f"},"content":{"rendered":"\n

Preventing New Gram-negative Resistance Through Beta-lactam De-escalation in Hospitalized Patients With Sepsis: A Retrospective Cohort Study <\/h1>\n\n\n\n

Besu F Teshome,  Taehwan Park,  Joel Arackal,  et al<\/h3>\n\n\n\n

Clinical Infectious Diseases<\/em>, Volume 79, Issue 4, 15 October 2024, Pages 826\u2013833, https:\/\/doi.org\/10.1093\/cid\/ciae253<\/a><\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Background<\/p>\n\n\n\n

Whether antibiotic de-escalation reduces the risk of subsequent antibiotic resistance is uncertain. We sought to determine if beta-lactam (BL) antibiotic de-escalation is associated with decreased incidence of new Gram-negative resistance in hospitalized patients with sepsis.<\/p>\n\n\n\n

Methods<\/p>\n\n\n\n

In a retrospective cohort study, patients with sepsis who were treated with at least 3 consecutive days of BL antibiotics, the first 2 days of which were with a broad-spectrum BL agent defined as a spectrum score (SS) of \u22657 were enrolled. Patients were grouped into three categories: (1) de-escalation of beta-lactam spectrum score (BLSS), (2) no change in BLSS, or (3) escalation of BLSS. The primary outcome was the isolation of a new drug-resistant Gram-negative bacteria from a clinical culture within 60 days of cohort entry. Fine-Gray proportional hazards regression modeling while accounting for in-hospital death as a competing risk was performed.<\/p>\n\n\n\n

Findings<\/p>\n\n\n\n

Six hundred forty-four patients of 7742 (8.3%) patients developed new gram-negative resistance. The mean time to resistance was 23.7 days yielding an incidence rate of 1.85 (95% confidence interval [CI]: 1.71\u20132.00) per 1000 patient-days. The lowest incidence rate was observed in the de-escalated group 1.42 (95% CI: 1.16\u20131.68) per 1000 patient-days. Statistically significant reductions in the development of new gram-negative resistance were associated with BL de-escalation compared to no-change (hazards ratio (HR) 0.59 [95% CI: .48\u2013.73]).<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions<\/p>\n\n\n\n

De-escalation was associated with a decreased risk of new resistance development compared to no change. This represents the largest study to date showing the utility of de-escalation in the prevention of antimicrobial resistance.<\/p>\n","protected":false},"excerpt":{"rendered":"

Preventing New Gram-negative Resistance Through Beta-la […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27211"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=27211"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27211\/revisions"}],"predecessor-version":[{"id":27605,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27211\/revisions\/27605"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27211"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27211"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27211"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}