Extended Infusion of β-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis: An Observational Multicenter Study

ESGBIS/BICHROME Study Group

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)1731-1739
Number of pages9
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume69
Issue number10
DOIs
Publication statusPublished - Oct 30 2019

Fingerprint

Lactams
Liver Cirrhosis
Multicenter Studies
Observational Studies
Carbapenems
Confidence Intervals
Infection
Mortality
Propensity Score
beta-Lactams
Proportional Hazards Models
End Stage Liver Disease
Therapeutics
Sepsis
Prospective Studies

Keywords

  • bloodstream infection
  • continuous infusion
  • liver cirrhosis
  • β-lactam antibiotics

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{c1b3b69f55f04ec2b6bfb5bdc6ef30ed,
title = "Extended Infusion of β-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis: An Observational Multicenter Study",
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.",
keywords = "bloodstream infection, continuous infusion, liver cirrhosis, β-lactam antibiotics",
author = "{ESGBIS/BICHROME Study Group} and Michele Bartoletti and Maddalena Giannella and Lewis, {Russell E.} and Paolo Caraceni and Sara Tedeschi and Mical Paul and Christoph Schramm and Tony Bruns and Manuela Merli and Nazaret Cobos-Trigueros and Elena Seminari and Pilar Retamar and Patricia Mu{\~n}oz and Mario Tumbarello and Patrizia Burra and {Torrani Cerenzia}, Maria and Bruno Barsic and Ester Calbo and Maraolo, {Alberto Enrico} and Nicola Petrosillo and Galan-Ladero, {Maria Angeles} and Gianpiero D'Offizi and Yael Zak-Doron and Jesus Rodriguez-Ba{\~n}o and Maurizio Baldassarre and Gabriella Verucchi and Marco Domenicali and Mauro Bernardi and Pierluigi Viale",
year = "2019",
month = "10",
day = "30",
doi = "10.1093/cid/ciz032",
language = "English",
volume = "69",
pages = "1731--1739",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "NLM (Medline)",
number = "10",

}

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 -