Clinical Benefit of Appropriate Empirical Fluoroquinolone Therapy for Adults with Community-Onset Bacteremia in Comparison with Third-Generation-Cephalosporin Therapy

doi:10.1128/AAC.02174-16

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Title:	Clinical Benefit of Appropriate Empirical Fluoroquinolone Therapy for Adults with Community-Onset Bacteremia in Comparison with Third-Generation-Cephalosporin Therapy
Authors:	Lee, Ching-Chi Wang, Jiun-Ling Lee, Chung-Hsun Hsieh, Chih-Chia Hung, Yuan-Pin Hong, Ming-Yuan Tang, Hung-Jen Ko, Wen-Chien
Contributors:	Madou Sin Lau Hosp, Dept Internal Med, Div Crit Care Med Chang Jung Christian Univ, Grad Inst Med Sci, Coll Hlth Sci Natl Cheng Kung Univ, Dept Internal Med,Natl Cheng Kung Univ Hosp, Coll Med Natl Cheng Kung Univ, Dept Med, Coll Med Natl Cheng Kung Univ, Dept Emergency Med,Natl Cheng Kung Univ Hosp, Coll Med Minist Hlth & Welf, Dept Internal Med, Tainan Hosp Chi Mei Med Ctr, Dept Med Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr
Keywords:	fluoroquinolone third-generation cephalosporin empirical therapy community onset bacteremia defervescence
Date:	2017-02
Issue Date:	2018-11-30 15:49:28 (UTC+8)
Publisher:	Amer Soc Microbiology
Abstract:	Both fluoroquinolones (FQs) and third-generation cephalosporins (3rd-GCs) are commonly prescribed to treat bloodstream infections, but comparative efficacies between them were rarely studied. Demographics and clinical characteristics of 733 adults with polymicrobial or monomicrobial community-onset bacteremia empirically treated by an appropriate FQ (n = 87) or 3rd-GC (n = 646) were compared. A critical illness (respectively, 8.0% versus 19.0%; P = 0.01), an initial syndrome with severe sepsis (33.3% versus 50.3%; P = 0.003), or a fatal outcome at 28 days (4.6% versus 10.5%; P = 0.08) was less common in the FQ group. A total of 645 (88.0%) patients were febrile at initial presentation, and the FQ group with (FQ group versus 3rd-GC group, respectively, 7.6 days versus 12.0 days; P = 0.04) and without (3.8 days versus 5.4 days; P = 0.001) a critical illness had a shorter time to defervescence than the 3rd-GC group. By the propensity scores, 87 patients with appropriate FQ therapy were matched with 435 treated by 3rd-GC therapy at a ratio of 1: 5, and there were no significant differences in terms of bacteremia severity, comorbidity severity, major comorbidities, causative microorganisms, and bacteremia sources between groups. Moreover, crude mortality rates at 28 days (FQ group versus 3rd-GC group, respectively, 4.6% versus 7.8%; P = 0.29) did not differ significantly. However, the time to defervescence was shorter in the FQ group (4.2 +/- 3.6 versus 6.2 +/- 7.6 days; P = 0.001). Conclusively in the adults with community-onset bacteremia, appropriate empirical FQ therapy was related to shorter time to defervescence than with 3rd-GC therapy, at least for those without a critical illness.
Relation:	Antimicrobial Agents and Chemotherapy, v.61, n.2, e02174-16
Appears in Collections:	[Dept. of Health and Nutrition (including master's program)] Periodical Articles

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