Clinical Benefit of Empiric High-Dose Levofloxacin Therapy for Adults With Community-onset plates Enterobacteriaceae Bacteremia

doi:10.1016/j.clinthera.2019.07.010

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Title:	Clinical Benefit of Empiric High-Dose Levofloxacin Therapy for Adults With Community-onset plates Enterobacteriaceae Bacteremia
Authors:	Lee, Ching-Chi Yang, Chao-Yung Lee, Chung-Hsun Hsieh, Chih-Chia Hong, Ming-Yuan Hung-Jen Tang(湯宏仁) Ko, Wen-Chien
Contributors:	Tainan Sin Lau Hosp, Dept Adult Crit Care Med Chang Jung Christian Univ, Coll Hlth Sci, Grad Inst Med Sci Natl Cheng Kung Univ, Natl Cheng Kung Univ Hosp, Coll Med, Dept Emergency Med Natl Cheng Kung Univ, Coll Med, Dept Med Chi Mei Med Ctr, Dept Med Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr Natl Cheng Kung Univ, Natl Cheng Kung Univ Hosp, Coll Med, Dept Internal Med
Keywords:	bacteremia defervescence empiric therapy Enterobacteriaceae high-dose levofloxacin
Date:	2019-10
Issue Date:	2020-07-29 13:48:19 (UTC+8)
Publisher:	ELSEVIER
Abstract:	Purpose: Levofloxacin is commonly prescribed to treat varied community-acquired gram-negative infections; knowledge of the therapeutic efficacies of high-dose (HD) administration is helpful to improve patient care. Methods: In this 6-year cohort, adults with community-onset Enterobacteriaceae bacteremia were retrospectively studied in 2 hospitals. To overcome the confounding factors in the dosage choice of empiric administration, patients receiving empiric intravenous HD (750 mg/d) therapy were matched with those receiving the conventional dose (CD; 500 mg/d) by using individual propensity scores, calculated by the independent predictors of 30-day crude mortality. Findings: Initially, more patients with critical illness (Pitt bacteremia score [PBS] >= 4) at bacteremia onset and comorbid malignancies and the higher 15- and 30-day mortality rate were recorded in 136 patients receiving HD therapy, compared to 103 receiving CD therapy. After appropriate matching, differences in patient demographic and clinical characteristics between the HD (n = 103) and CD (n = 103) groups were nonsignificant. Consequently, crude mortality rates at 3, 15, or 30 days after onset of bacteremia did not differ. However, the period of time to defervescence, total intravenous antimicrobial administration, and hospital stay was shorter in the HD group than in the CD group. Similarly, regardless if patients had more critical illness (PBS >= 2) or stabilized illness (PBS <2), the advantage of empiric HD therapy on defervescence remained significant. Within 60 days after discontinuation of intravenous levofloxacin therapy, the proportion of recurrent bacteremia, posttreatment overall infections, and posttreatment crude mortality was similar between the HD and CD groups. (C) 2019 Published by Elsevier Inc.
Relation:	Clinical the rapeutics, v.41, n.10, pp.1996-2007
Appears in Collections:	[Dept. of Health and Nutrition (including master's program)] Periodical Articles

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