Ceftriaxone Versus Cefepime or Carbapenems for Definitive Treatment of Low-Risk AmpC-Harboring Enterobacterales Bloodstream Infections in Hospitalized Adults: A Retrospective Cohort Study

Document Type

Article

Publication Date

1-1-2025

Publication Title

Diagnostic microbiology and infectious disease

Abstract

OBJECTIVE: To compare outcomes of ceftriaxone to AmpC-stable therapies in patients with bacteremia caused by low-risk AmpC harboring Enterobacterales.

METHODS: IRB-approved, retrospective cohort of hospitalized patients ≥18 years old with Serratia marcescens, Morganella morganii, or Providencia spp. bacteremia from 1/1/2017-2/28/2024. Patients were compared by definitive therapy with ceftriaxone vs AmpC-stable therapy (cefepime, carbapenem). The primary endpoint was 30-day all-cause mortality; secondary endpoints were clinical failure and development of ceftriaxone resistance.

RESULTS: 163 patients were included; 33.1 % received ceftriaxone, 66.9 % AmpC-stable therapies. 30-day all-cause mortality was 9.3 % ceftriaxone vs 10.1 % AmpC stable patients (P = 0.87); ceftriaxone definitive therapy was not associated with 30-day all-cause mortality (adjOR, 0.79; 95 %CI, 0.23-2.3). There were no differences in clinical failure (9.3 % vs 21.1 %, P = 0.059) or relapsing infection (5.6 % vs 9.3 %, P = 0.55) between ceftriaxone and AmpC-stable treated patients.

CONCLUSIONS: Patients treated with definitive ceftriaxone for low-risk AmpC Enterobacterales bacteremia had similar outcomes to AmpC stable therapies.

Medical Subject Headings

Humans; Retrospective Studies; Ceftriaxone; Male; Anti-Bacterial Agents; Bacteremia; Female; Middle Aged; Enterobacteriaceae Infections; beta-Lactamases; Aged; Bacterial Proteins; Cefepime; Carbapenems; Adult; Enterobacteriaceae; Aged, 80 and over; Microbial Sensitivity Tests; Treatment Outcome

PubMed ID

39427451

Volume

111

Issue

1

First Page

116557

Last Page

116557

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