Vol.70 No.4 July 2022
Efficacy of switching from initial intravenous cefmetazole treatment to oral antibiotic treatment in patients with bloodstream infection caused by ESBL-producing Escherichia coli
1)Department of Family Medicine, Izumo Medical Life Cooperative Izumo-shimin Hospital, 1536-1 Enya, Izumo, Shimane, Japan
2)Izumo-shimin Hospital Secretarial Division
Abstract
Background: There are several reports of the effectiveness of intravenous cefmetazole (CMZ) treatment in patients with bloodstream infection caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. However, there is no evidence of the usefulness of initial intravenous CMZ treatment and further, of switching to oral antibiotic therapy after initial intravenous CMZ treatment in patients with bloodstream infection caused by ESBL-producing E. coli. In this study, we investigated the effects of initial intravenous CMZ treatment followed by switch to oral antibiotic therapy in patients with bloodstream infection caused by ESBL-producing E. coli.
Materials and methods: A retrospective survey was conducted using data from a single facility. We investigated the 30-day mortality rate in adult patients with bloodstream infection caused by ESBL-producing E. coli who received initial intravenous CMZ treatment.
Results: Blood culture tests were performed on 1,064 patients, and E. coli alone was detected in 129 adult patients, and of the 62 patients with the infection caused by ESBL-producing E. coli, 44 received initial treatment with CMZ; the data of 42 patients were analyzed, after excluding 2 deaths that occurred within 24 hours after the onset. The median duration of administration of CMZ was 10 days [7, 14]. The 30-day mortality rate was 4.8%, while the mortality rate in the 22 patients who were switched from the initial CMZ treatment to oral antibiotic administration was 0%. The median duration of CMZ administration in the patients who were switched to oral antibiotic therapy was 7 days [6, 10].
Discussion: Initial CMZ treatment seems to be effective for patients with bloodstream infection caused by ESBL-producing E. coli. Furthermore, it may be possible to shorten the CMZ administration period and switch to oral antibiotic therapy in these patients.
Key word
extended-spectrum beta-lactamase, Escherichia coli, bacteremia, cefmetazole, oral switch therapy
Received
November 8, 2021
Accepted
April 7, 2022
Jpn. J. Chemother. 70 (4): 359-365, 2022
