JOURNAL ARTICLE

Does quick Sepsis-related Organ Failure Assessment (qSOFA) suggest the use of initial empirical carbapenem therapy in bacteremia caused by extended-spectrum β-lactamase-producing bacteria? A multicenter case-control study

Satoru Mitsuboshi, Naoki Tsuruma, Kazuya Watanabe, Shigehiro Takahashi, Manami Nakashita, Atsuko Ito, Kenichi Kobayashi, Masami Tsugita
Japanese Journal of Infectious Diseases 2018 October 31
30381688
We hypothesized that quick Sequential Organ Failure Assessment (qSOFA) would be associated with 30-day mortality in bacteremia caused by extended-spectrum β-lactamase (ESBL)-producing bacteria and might be a selection criterion for the use of carbapenem as initial empirical therapy. A multicenter retrospective study was conducted in six hospitals. All patients who had bacteremia due to ESBL-producing bacteria were included in the study. Multivariable logistic regression analysis was performed to analyze 30-day mortality as the main outcome. A total of 203 adult patients were identified with bacteremia caused by ESBL-producing Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis. In multivariate logistic regression analysis, bacteremia caused by ESBL-producing K. pneumoniae or P. mirabilis (odds ratio [OR] 5.07, 95% confidence interval [CI] 1.64-15.56), underlying liver disease (OR 3.38, 95% CI 1.09-10.00), and underlying solid cancer (OR 3.45, 95% CI 1.27-9.69) were associated with 30-day mortality. In a subgroup analysis, empirical non-carbapenem therapy was associated with 30-day mortality in bacteremia caused by ESBL-producing K. pneumoniae or P. Mirabilis. Our results suggest that qSOFA score is not a selection criterion for the use of carbapenem as initial empirical therapy.

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