感染症と治療ジャーナル

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Comparing the Outcomes Associated with Three Treatment Durations of Pseudomonas and Acinetobacter Bloodstream Infection

Jamal Wadi Al Ramahi, Ayad Abdullah Al-Qadasi, Sewar Saed Fraij, Ahmad Bassam Alayyat, Asma’a Rezeq Tanash, Nour Mohammad Hasan, Amal Matar, Renad Mohammad Khader, Asaiel Zaid Makahleh, Ibraheem Zuhair A.R. Mohialdeen, Haya Moh’d Hamarsha, Zaid Antwan Tewfiq Al Khouri, Zaid Ali Zuhair Elkarmi, Lara Abdulhadi, Farah A. Abdallah

Background: The proper duration for treating patients with non-fermenting gram-negative bacteremia is not yet defined; we attempt to find an appropriate course of treatment.

Methods: A retrospective multicenter study in three hospitals, Amman-Jordan. Medical records were reviewed for patients with Lactose Non-Fermenting Gram-Negative (LNF) bacteremia. Information on blood cultures was extracted from the microbiology logbook and records. For adults >18 years, primary bacteremia and a known source were included. Patients who needed prolonged antibiotics treatment due to the nature of their infections; neutropenic cancer patients, organs with abscesses/empyema, CVC retention, polymicrobial septicemia, and expected survival ≤ 48 hours. Continuous variables were analyzed by (χ²), Mann-Whitney test, ANOVA for means, and the Bonferroni for pairwise comparisons for P-value <0.05. SPSS version-25 was used in the analysis.

Results: Included patients were 115 with LNF gram-negative growth on blood cultures, distributed as follows: patients with one-week treatment duration were 45, two-week 43, and three-week duration was 27. Characteristics were balanced (P>0.05) except for chronic lung disease, and a few antibiotics were more in the three-week duration (P<0.05). There was a significant difference for 28-day all-cause mortality (P=0.019), but relapse and reinfection did not significantly differ among the three treatment durations (P>0.05). The relapse rate was 3%, and a new infection was 7%.

Conclusion: There was no significant difference for one-week, two-week, and three-week antibiotics treatment durations in the 90- day all-cause mortality, relapse, and reinfection rates, but increased 28-day mortality in the three-week duration.