Fluoroquinolones effective against Gram-negative bloodstream infections: Study

Increasing antimicrobial resistance rates limit empirical antimicrobial treatment options for Gram-negative bloodstream infections (GN-BSI). However, antimicrobial resistance may be predicted based on patient-specific risk factors using precision medicine concepts.

The researchers conducted a retrospective, cohort study and examined clinical outcomes in hospitalized adults without major risk factors for antimicrobial resistance receiving empirical fluoroquinolones or broad-spectrum beta-lactams (BSBL) for GN-BSI at Prisma Health-Midlands hospitals in Columbia, SC, the USA from January 2010 through June 2015.

They found that, in the absence of antibiotic resistance risk factors, empirical fluoroquinolones were as effective as broad-spectrum beta-lactams for treating gram-negative bloodstream infections (GN-BSIs). The study has been published in the Journal of Global Antimicrobial Resistance.

Empirical fluoroquinolones had equal effectiveness to broad-spectrum beta-lactams in Gram-negative bloodstream infections in the absence of antimicrobial resistance risk factors. Hospital length of stay was shorter in the fluoroquinolone than broad-spectrum beta-lactam group likely due to an earlier transition from intravenous to oral therapy.

The researchers examined clinical outcomes in adults without risk factors for antibiotic resistance who were hospitalized with GN-BSIs and treated empirically with either fluoroquinolones (74 patients) or broad-spectrum beta-lactams (148 patients). The primary outcomes studied were early treatment failure at 72 to 96 hours, 28-day mortality, and hospital length of stay.

Early treatment failure rates were comparable in the fluoroquinolone and broad-spectrum beta-lactam groups (27% vs 30%, respectively; odds ratio, 0.82; 95% confidence interval [CI], 0.43 to 1.54; P = .53), as were 28-day mortality rates (8.9% vs 9.7%, respectively; hazard ratio [HR], 0.74; 95% CI, 0.26 to 1.90; P = 0.54). The median hospital length of stay was 6.1 days in the fluoroquinolone group and 7.1 days in the broad-spectrum beta-lactam group (HR, 0.73; 95% CI, 0.54 to 0.99; P = 0.04).

The transition from intravenous to oral therapy also occurred earlier in the fluoroquinolone group (3.0 vs 4.9 days, P < 0.001). The researchers suggest the earlier transition to oral therapy for fluoroquinolone patients may be the reason for the shorter hospital stays.

The investigators concluded that in the absence of antimicrobial resistance risk factors, fluoroquinolones provide an additional empirical treatment option to BSBL for GN-BSI. Shorter HLOS in the fluoroquinolone group may be due to an earlier transition from intravenous to oral antimicrobial therapy.

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