Empiric aztreonam is associated with increased mortality compared to beta-lactams in septic shock
Copyright © 2021 Elsevier Inc. All rights reserved..
PURPOSE: To determine if aztreonam as initial empiric treatment of adult septic shock is associated with increased mortality compared to the use of anti-pseudomonal beta-lactam agents.
METHODS: This was a multicenter, retrospective cohort study of 582 adult emergency department patients admitted to 12 acute care facilities within a single health system from January 2014 to December 2017 with septic shock receiving either aztreonam or an anti-pseudomonal beta-lactam for empiric treatment and discharged with an infection-related ICD-9 or ICD-10 code. The primary endpoint was in-hospital mortality.
RESULTS: Initial exposure to aztreonam was associated with increased hospital mortality compared to treatment with an anti-pseudomonal beta-lactam agent (22.7% vs. 12.9%, OR = 1.98, 95% CI: 1.27-3.11). When adjusted for APACHE II score, the treatment group effect on mortality remained statistically significant (OR = 1.74, 95% CI: 1.08-2.80). Aztreonam use was also associated with increased utilization of aminoglycosides (28.9% vs. 12.4%, p < 0.0001) and fluoroquinolones (50.5% vs. 25.8%, p < 0.01). There was no difference in hospital or intensive care unit length of stay in surviving patients between the two groups.
CONCLUSIONS: Compared to anti-pseudomonal beta-lactams, empiric treatment with aztreonam is associated with increased mortality and greater antibiotic exposure among patients with acute septic shock. These findings suggest that treatment with anti-pseudomonal beta-lactams should be prioritized over allergy avoidance whenever feasible.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:48 |
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| Enthalten in: |
The American journal of emergency medicine - 48(2021) vom: 15. Okt., Seite 255-260 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Jaffa, Rupal K [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 25.10.2021 Date Revised 25.10.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ajem.2021.04.085 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM325556032 |
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| 245 | 1 | 0 | |a Empiric aztreonam is associated with increased mortality compared to beta-lactams in septic shock |
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| 500 | |a Date Revised 25.10.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 Elsevier Inc. All rights reserved. | ||
| 520 | |a PURPOSE: To determine if aztreonam as initial empiric treatment of adult septic shock is associated with increased mortality compared to the use of anti-pseudomonal beta-lactam agents | ||
| 520 | |a METHODS: This was a multicenter, retrospective cohort study of 582 adult emergency department patients admitted to 12 acute care facilities within a single health system from January 2014 to December 2017 with septic shock receiving either aztreonam or an anti-pseudomonal beta-lactam for empiric treatment and discharged with an infection-related ICD-9 or ICD-10 code. The primary endpoint was in-hospital mortality | ||
| 520 | |a RESULTS: Initial exposure to aztreonam was associated with increased hospital mortality compared to treatment with an anti-pseudomonal beta-lactam agent (22.7% vs. 12.9%, OR = 1.98, 95% CI: 1.27-3.11). When adjusted for APACHE II score, the treatment group effect on mortality remained statistically significant (OR = 1.74, 95% CI: 1.08-2.80). Aztreonam use was also associated with increased utilization of aminoglycosides (28.9% vs. 12.4%, p < 0.0001) and fluoroquinolones (50.5% vs. 25.8%, p < 0.01). There was no difference in hospital or intensive care unit length of stay in surviving patients between the two groups | ||
| 520 | |a CONCLUSIONS: Compared to anti-pseudomonal beta-lactams, empiric treatment with aztreonam is associated with increased mortality and greater antibiotic exposure among patients with acute septic shock. These findings suggest that treatment with anti-pseudomonal beta-lactams should be prioritized over allergy avoidance whenever feasible | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Antimicrobials | |
| 650 | 4 | |a Aztreonam | |
| 650 | 4 | |a Hypersensitivity | |
| 650 | 4 | |a Septic shock | |
| 650 | 7 | |a Aminoglycosides |2 NLM | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 650 | 7 | |a Fluoroquinolones |2 NLM | |
| 650 | 7 | |a beta-Lactams |2 NLM | |
| 650 | 7 | |a Piperacillin, Tazobactam Drug Combination |2 NLM | |
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| 650 | 7 | |a Cefepime |2 NLM | |
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| 650 | 7 | |a Meropenem |2 NLM | |
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| 700 | 1 | |a Medaris, Leigh Ann |e verfasserin |4 aut | |
| 700 | 1 | |a Anderson, William E |e verfasserin |4 aut | |
| 700 | 1 | |a Heffner, Alan C |e verfasserin |4 aut | |
| 700 | 1 | |a Pillinger, Kelly E |e verfasserin |4 aut | |
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