Efficacy Comparison between Ertapenem and Flomoxef for Treatment of Hemodialysis Access-Related Bacteremia Secondary to Klebsiella pneumoniae in Critically Ill Hemodialysis Patients

• Main Authors: Chih-Chao Yang, 楊智超
• Other Authors: Chung-Lung Cho
• Format: Others
• Language: en_US
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/f2bfss

碩士 === 國立中山大學 === 生物科學系研究所 === 102 === Background In the face of increasing treatment options for extended spectrum beta-lactamase (ESBL)-producing Klebsiella pneumonia (ESBL-Kp) hemodialysis (HD) access-related bacteremia, the difference of clinical effectiveness between ertapenem and flomoxef remains unclear. We conducted this retrospective study to determine their efficacy and treatment outcome. Methods Patients on maintenance HD with fistula, graft or catheter- related ESBL-Kp bacteremia were enrolled. The data of clinical features and antibiotic treatments were collected. Outcome was determined by mortality resulting from bacteremia during the 14‐day period after the collection day of first positive blood culture for flomoxef-susceptible ESBL-Kp. Results The 64 patients studied had severe septicemia as determined by the Pitt bacteremia score (PBS) and had a predisposition to stay in the intensive care unit(ICU) at the time of bacteremia (32/64,50%). Old age (&;gt;65 years, 57.8%), malnutrition (albumin&;lt;3.5g/dL, 92.2%), with a history of severe illnesses (defined by shock, intubation or ICU stay, 82.5%) and prolonged hospitalization (&;gt;30 days, 75%) prior to the onset of bacteremia were also highly prevalent. The study population comprised 9 fistula, 10 graft, and 45 HD catheter-related bacteremia (CRB) cases, and the mortality rate was high (38/64, 59.4%). Mortality rate is significant higher in flomoxef treatment group than in ertapenem treatment group (22/30, 73% versus16/34, 47%, p&;lt;0.05). Among patients with CRB, failure to receive appropriate empiric antibiotics (flomoxef or ertapenem) within 5 days after onset of bacteremia and treatment with flomoxef were identified as risk factors for mortality. Multivariate analyses revealed that flomoxef use and PBS were independently associated with mortality (OR, 2.52; 95% CI, 1.34-35.17 and OR, 4.37; 95% CI, 1.28-5.26, respectively). Conclusions HD patients with critical illness are susceptible to ESBL-Kp HD access-related bacteremia and have poor outcomes. Ertapenem rather than flomoxef should be the therapy of choice in these vulnerable patients.