The effects of switching from ceftriaxone to cefotaxime on the occurrence of third-generation cephalosporin-resistant Enterobacterales: A stepped-wedge cluster randomized trial - 25/01/24
, Houssein Gbaguidi-Haore b, c, Didier Hocquet b, c, Thomas Crépin d, Daniel Wendling e, Sophie Borot f, Catherine Chirouze a, c, Xavier Bertrand b, cHighlights |
• | The cefotaxime/ceftriaxone ratio was inversely correlated with 3GC-RE incidence. |
• | Replacing ceftriaxone with cefotaxime reduces the incidence of positive 3GC-RE clinical samples in hospitalized patients. |
• | Imported 3GC-RE was also associated with the incidence of acquired cases of 3GC-RE. |
Abstract |
Objectives |
To evaluate the effects of the replacement of ceftriaxone by cefotaxime on the incidence of third-generation cephalosporin-resistant Enterobacterales (3GC-RE).
Patients and methods |
We conducted a 24-month monocentric prospective, stepped-wedge cluster randomized controlled trial. During the control phase of the study, clinicians prescribed either ceftriaxone or cefotaxime. During the intervention phase, they systematically prescribed cefotaxime.
Results |
The cefotaxime/ceftriaxone ratio was inversely correlated with the incidence of 3GC-RE. All in all, 3GC-RE incidence was 1.05 (27/25,692) acquired cases/1000 hospitalization days during the control phase and 0.54 (11/20,419) acquired cases/1000 hospitalization days during the intervention phase (incidence rate ratio [IRR] = 0.51 [0.22–1.07], p = 0.06). In multivariable analysis, intervention phase (versus control phase) (p = 0.007), cefotaxime/ceftriaxone ratio (p = 0.003) and imported 3GC-RE (p = 0.005) were associated with the incidence of acquired cases of 3GC-RE.
Conclusions |
We found that replacing ceftriaxone with cefotaxime reduced the occurrence of 3GC-RE isolates. More studies are needed to confirm these results.
Le texte complet de cet article est disponible en PDF.Keywords : Ceftriaxone, Third-generation cephalosporins, Enterobacterales, Antimicrobial stewardship, Antimicrobial resistance
Plan
Vol 54 - N° 1
Article 104806- février 2024 Retour au numéro
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