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A Real-World Study Comparing Various Antimicrobial Regimens for Bloodstream Infections Caused by Carbapenem-Resistant Gram-Negative Bacilli in a Tertiary Hospital, Shanghai, China, from 2010 to 2017

Authors Tan J, Yu W, Wu G, Shen J, Fang Y, Zhu H, Xiao Q, Peng W, Lan Y, Gong Y

Received 27 January 2020

Accepted for publication 16 June 2020

Published 21 July 2020 Volume 2020:13 Pages 2453—2463

DOI https://doi.org/10.2147/IDR.S247378

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Suresh Antony


Jiaying Tan,1,* Wenjin Yu,2,* Gang Wu,1 Jun Shen,1 Yong Fang,1 Hechen Zhu,1 Qianyi Xiao,3 Weixia Peng,3 Yukun Lan,3 Ye Gong1

1Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai 200040, People’s Republic of China; 2Department of Pharmacy , Huashan Hospital, Fudan University, Shanghai 200040, People’s Republic of China; 3Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ye Gong Email gong_ye@fudan.edu.cn

Background: We conducted a real-world analysis of the effectiveness of different antibiotic regimens for bloodstream infections (BSIs) caused by carbapenem-resistant gram-negative bacilli (CR-GNB) in a Chinese population.
Methods: A retrospective observational study was conducted between January 2010 and December 2017. Patients with BSIs caused by CR-GNB confirmed by in vitro susceptibility tests were enrolled, and patient medical record data on antimicrobial agents and microbiological and clinical outcomes were extracted.
Results: A total of 175 individuals were included; 127 individuals (72.6%) received combination therapy (two or more antibiotics), while 48 individuals (27.4%) received monotherapy (single antibiotic). The all-cause 28-day mortality was 20.0%. Treatment success or presumed success rates were very similar between the monotherapy and combination therapy groups (58.3% versus 59.1%; P = 0.931). Combination therapy had a higher success rate trend than monotherapy in septic shock patients (40.7% versus 18.2%; P = 0.268). Improved therapeutic effects were observed in the active agent-containing group, although the differences were not significant.
Conclusion: Combination therapy likely has better therapeutic effects on critical BSIs caused by CR-GNB than monotherapy. Choosing a proper active agent in an antimicrobial regime is relatively crucial to the ultimate treatment outcome.

Keywords: bloodstream infection, carbapenem-resistant gram-negative bacilli, antimicrobial regimen, treatment success rate, real-world, Chinese population

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