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.
| Original language | English |
|---|---|
| Pages (from-to) | 1731-1739 |
| Number of pages | 9 |
| Journal | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America |
| Volume | 69 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - Oct 30 2019 |
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Keywords
- bloodstream infection
- continuous infusion
- liver cirrhosis
- β-lactam antibiotics
ASJC Scopus subject areas
- Microbiology (medical)
- Infectious Diseases
Cite this
Extended Infusion of β-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis : An Observational Multicenter Study. / ESGBIS/BICHROME Study Group.
In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol. 69, No. 10, 30.10.2019, p. 1731-1739.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Extended Infusion of β-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis
T2 - An Observational Multicenter Study
AU - ESGBIS/BICHROME Study Group
AU - Bartoletti, Michele
AU - Giannella, Maddalena
AU - Lewis, Russell E.
AU - Caraceni, Paolo
AU - Tedeschi, Sara
AU - Paul, Mical
AU - Schramm, Christoph
AU - Bruns, Tony
AU - Merli, Manuela
AU - Cobos-Trigueros, Nazaret
AU - Seminari, Elena
AU - Retamar, Pilar
AU - Muñoz, Patricia
AU - Tumbarello, Mario
AU - Burra, Patrizia
AU - Torrani Cerenzia, Maria
AU - Barsic, Bruno
AU - Calbo, Ester
AU - Maraolo, Alberto Enrico
AU - Petrosillo, Nicola
AU - Galan-Ladero, Maria Angeles
AU - D'Offizi, Gianpiero
AU - Zak-Doron, Yael
AU - Rodriguez-Baño, Jesus
AU - Baldassarre, Maurizio
AU - Verucchi, Gabriella
AU - Domenicali, Marco
AU - Bernardi, Mauro
AU - Viale, Pierluigi
PY - 2019/10/30
Y1 - 2019/10/30
N2 - 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.
AB - 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.
KW - bloodstream infection
KW - continuous infusion
KW - liver cirrhosis
KW - β-lactam antibiotics
UR - http://www.scopus.com/inward/record.url?scp=85069655554&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85069655554&partnerID=8YFLogxK
U2 - 10.1093/cid/ciz032
DO - 10.1093/cid/ciz032
M3 - Article
C2 - 30649218
AN - SCOPUS:85069655554
VL - 69
SP - 1731
EP - 1739
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
IS - 10
ER -