Your browser doesn't support javascript.

Biblioteca Virtual em Saúde

Brasil

Home > Pesquisa > ()
Imprimir Exportar

Formato de exportação:

Exportar

Email
Adicionar mais destinatários
| |

Extended infusion of ß-lactams for bloodstream infection in patients with liver cirrhosis: an observational multicenter study.

Bartoletti, Michele; Giannella, Maddalena; Lewis, Russell E; Caraceni, Paolo; Tedeschi, Sara; Paul, Mical; Schramm, Christoph; Bruns, Tony; Merli, Manuela; Cobos-Trigueros, Nazaret; Seminari, Elena; Retamar, Pilar; Muñoz, Patricia; Tumbarello, Mario; Burra, Patrizia; Cerenzia, Maria Torrani; Barsic, Bruno; Calbo, Ester; Maraolo, Alberto Enrico; Petrosillo, Nicola; Galan-Ladero, Maria Angeles; D'Offizi, Gianpiero; Zak-Doron, Yael; Rodriguez-Baño, Jesus; Baldassarre, Maurizio; Verucchi, Gabriella; Domenicali, Marco; Bernardi, Mauro; Viale, Pierluigi.
Clin Infect Dis; 2019 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-30649218

METHODS:

The BICRHOME study was a prospective, multicenter study enrolling 312 cirrhotic patients with BSI. In this secondary analysis we selected patients receiving TZP or carbapenems as adequate empiric 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 empiric treatment. Patients who received C/EI had a significantly lower mortality rate (16% vs 36%, P=0.047). In a Cox-regression model, the administration of C/EI was associated with a significantly lower mortality [HR 0.41(95% CI 0.11-0.936), P=0.04] 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<0.0001) estimated with propensity score matching. A significant reduction of 30-day mortality was also observed in the subgroups of patients with sepsis [HR 0.21 (95%CI 0.06-0.74), P=0.015)], acute-on-chronic liver failure [HR 0.29 (95%CI 0.03-0.99] and a MELD score ≥ 25 [HR 0.26 (95%CI 0.08-0.92), P=0.048)]. At competing risk analysis, C/EI of beta-lactams was associated with a significantly higher rates of hospital discharge [SHR (95%CI): 1.62 (1.06-2.47); P=0.026].

CONCLUSION:

C/EI of beta-lactams in cirrhotic patients with BSI may improve outcomes and facilitate earlier discharge.
Selo DaSilva