{"id":27516,"date":"2025-03-03T04:58:00","date_gmt":"2025-03-02T20:58:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=27516"},"modified":"2025-03-03T05:54:02","modified_gmt":"2025-03-02T21:54:02","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e9%92%88%e5%af%b9%e8%82%a0%e6%9d%86%e8%8f%8c%e8%8f%8c%e8%a1%80%e7%97%87%e7%9a%84%e6%97%a9%e6%9c%9f%e8%a1%a8%e5%9e%8b%e7%9b%b8%e5%85%b3","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=27516","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u9488\u5bf9\u80a0\u6746\u83cc\u83cc\u8840\u75c7\u7684\u65e9\u671f\u8868\u578b\u76f8\u5173\u6297\u751f\u7d20\u6cbb\u7597\u7684\u4e34\u5e8a\u9884\u540e"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Infectious Diseases<\/p>\n\n\n\n

December 23, 2024<\/p>\n\n\n\n

Clinical Outcomes of Early Phenotype-Desirable Antimicrobial Therapy for Enterobacterales<\/em> Bacteremia<\/h1>\n\n\n\n

Rena C. Moon, Shawn H. MacVane, Joy David, et al<\/h3>\n\n\n\n

JAMA Netw Open. <\/em>2024;7(12):e2451633. doi:10.1001\/jamanetworkopen.2024.51633<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Is the timing of phenotype-desirable antimicrobial therapy (PDAT; ie, a \u03b2-lactam antibiotic with the narrowest spectrum of activity to effectively treat the pathogen\u2019s phenotype) associated with clinical outcomes among patients hospitalized with Enterobacterales<\/em> bloodstream infections?<\/p>\n\n\n\n

Findings<\/strong>  In this cohort study with 8193 adult patients, those receiving early PDAT had a 52.5% probability of a more desirable clinical outcome than patients receiving delayed PDAT. The observation persisted in the adjusted analysis, as patients receiving early PDAT had a 52.0% probability for a better clinical outcome than patients receiving delayed PDAT.<\/p>\n\n\n\n

Meaning<\/strong>  In this study, receiving early PDAT was associated with favorable 30-day clinical outcomes among patients hospitalized with Enterobacterales<\/em> bloodstream infections.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Initiating effective therapy early is associated with improved survival among patients hospitalized with gram-negative bloodstream infections; furthermore, providing early phenotype-desirable antimicrobial therapy (PDAT; defined as receipt of a \u03b2-lactam antibiotic with the narrowest spectrum of activity to effectively treat the pathogen\u2019s phenotype) is crucial for antimicrobial stewardship. However, the timing of targeted therapy among patients hospitalized with gram-negative bloodstream infections is not well understood.<\/p>\n\n\n\n

Objective<\/strong>  To compare the clinical outcomes between patients who were hospitalized with Enterobacterales<\/em> bloodstream infections receiving early vs delayed PDAT.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This retrospective cohort study used a large, geographically diverse, hospital-based US database (PINC AI Healthcare Database). Participants were adult (aged \u226518 years) patients with an inpatient admission between January 1, 2017, and June 30, 2022, with at least 1 blood culture isolate positive for Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae<\/em>, or Proteus mirabilis<\/em> and receiving PDAT on blood culture collection days 0 to 4.<\/p>\n\n\n\n

Exposure<\/strong>  Early vs delayed PDAT, with early PDAT defined as receipt of PDAT on blood culture collection days 0 to 2.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The main outcome was desirability of outcome ranking, in which patients were assigned a mutually exclusive rank 1 through 5. Rank 1 indicated the most desirable outcome (alive with no events), whereas rank 5 indicated the least desirable outcome and included all patients who died within 30 days of blood culture collection.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among 8193 eligible patients (mean [SD] age, 69.0 [16.4] years; 4758 [58.1%] female; 1200 [14.6%] African American or Black, 729 [8.9%] Hispanic, and 5778 [70.5%] White) from 252 hospitals, 5033 (61.4%) received early PDAT. Patients receiving early PDAT were similar in age (mean [SD], 68.2 [16.9] vs 70.3 [15.6] years) but more likely to have a lower median (IQR) Charlson-Deyo comorbidity score (2 [1-5] vs 3 [1-5]) compared with patients receiving delayed PDAT. After adjusting for comorbidities and severity of illness, patients receiving early PDAT were 20% less likely to be readmitted within 30 days compared with those receiving delayed PDAT (odds ratio, 0.80; 95% CI, 0.69-0.92;\u00a0P<\/em>\u2009<\u2009.001). A higher percentage of patients receiving early PDAT had a desirability of outcome ranking of 1 compared with patients receiving delayed PDAT (56.3% vs 52.2%,\u00a0P<\/em>\u2009<\u2009.001). Those receiving early PDAT had a 52.5% probability (95% CI, 51.3%-53.7%) of a more desirable outcome than those receiving delayed PDAT, a finding that persisted in the adjusted analysis (probability, 52.0%; 95% CI, 50.9%-53.2%).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Receiving early PDAT was associated with favorable 30-day clinical outcomes among patients hospitalized with Enterobacterales<\/em> blood stream infections. Early PDAT may be important not only for antimicrobial stewardship but also for improving patient outcomes.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Infectious Diseases Decemb […]<\/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\/27516"}],"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=27516"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27516\/revisions"}],"predecessor-version":[{"id":27847,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27516\/revisions\/27847"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27516"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27516"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27516"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}