Empiric aztreonam is associated with increased mortality compared to beta-lactams in septic shock - 09/10/21
, John Hammer, PharmD, MBA a , Leigh Ann Medaris, MD b , William E. Anderson, MS c, Alan C. Heffner, MD d, e , Kelly E. Pillinger, PharmD f Abstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Septic shock, Aztreonam, Antimicrobials, Hypersensitivity
Plan
| ☆ | Previously presented as a poster at: IDWeek 2020 (sponsored by the Infectious Diseases Society of America) in October 2020. |
Vol 48
P. 255-260 - octobre 2021 Retour au numéro
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