OBJECTIVES There is debate on whether the use of third-generation cephalosporins (3GC) increases the risk of clinical failure in bloodstream infections (BSIs) caused by chromosomally-mediated AmpC-producing Enterobacterales (CAE). This study evaluates the impact of definitive 3GC therapy versus other antibiotics on clinical outcomes in BSIs due to Enterobacter, Serratia, or Citrobacter species. METHODS This multicenter, retrospective cohort study evaluated adult hospitalized patients with BSIs secondary to Enterobacter, Serratia, or Citrobacter species from 1 January 2006 to 1 September 2014. Definitive 3GC therapy was compared to definitive therapy with other non-3GC antibiotics. Multivariable Cox proportional hazards regression evaluated the impact of definitive 3GC on overall treatment failure (OTF) as a composite of in-hospital mortality, 30-day hospital readmission, or 90-day reinfection. RESULTS A total of 381 patients from 18 institutions in the southeastern United States were enrolled. Common sources of BSIs were the urinary tract and central venous catheters (78 (20.5%) patients each). Definitive 3GC therapy was utilized in 65 (17.1%) patients. OTF occurred in 22/65 patients (33.9%) in the definitive 3GC group vs. 94/316 (29.8%) in the non-3GC group (p = 0.51). Individual components of OTF were comparable between groups. Risk of OTF was comparable with definitive 3GC therapy vs. definitive non-3GC therapy (aHR 0.93, 95% CI 0.51-1.72) in multivariable Cox proportional hazards regression analysis. CONCLUSIONS These outcomes suggest definitive 3GC therapy does not significantly alter the risk of poor clinical outcomes in the treatment of BSIs secondary to Enterobacter, Serratia, or Citrobacter species compared to other antimicrobial agents.

中文翻译：

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多中心，观察性队列研究评估第三代头孢菌素疗法对肠杆菌，沙雷氏菌和柠檬酸杆菌继发的血液感染的疗效。

目的关于使用第三代头孢菌素（3GC）是否会增加由染色体介导的产生AmpC的肠杆菌（CAE）引起的血液感染（BSI）临床失败的风险，存在争议。这项研究评估了确定性3GC治疗与其他抗生素相比，对由于肠杆菌，沙雷氏菌或柠檬酸杆菌引起的BSI临床结果的影响。方法这项多中心，回顾性队列研究评估了2006年1月1日至2014年9月1日住院的继发于肠杆菌，沙雷氏菌或柠檬酸杆菌属的BSI的成年BSI患者。将确定的3GC治疗与使用其他非3GC抗生素的确定治疗进行了比较。多变量Cox比例风险回归评估了确定性3GC对综合治疗失败（OTF）的影响，综合原因是院内死亡率，住院30天或90天再感染。结果共有来自美国东南部18个机构的381名患者入组。BSI的常见来源是尿路和中央静脉导管（每例78名（20.5％）患者）。明确的3GC治疗被用于65（17.1％）位患者。明确的3GC组中有22/65名患者（33.9％）发生了OTF，而非3GC组中有94/316（29.8％）发生了OTF（p = 0.51）。组间OTF的各个组成部分具有可比性。在多变量Cox比例风险回归分析中，OTF的风险与确定的3GC治疗与确定的非3GC治疗相当（aHR 0.93，95％CI 0.51-1.72）。结论这些结果表明，明确的3GC治疗不会显着改变肠杆菌继发性BSI治疗中不良临床结果的风险，