October 16, 2021
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Sanders reports that he has received grants or contracts with the Society of Infectious Diseases Pharmacists’ Young Investigator Award and the Merck Investigator Initiated Research Grant paid to his institution here for research outside of the work submitted. Cutrell and Tamma do not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.
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Administering a beta-lactam antibiotic before vancomycin significantly reduced the death rate in patients treated for circulatory infections, according to a study published in Clinical Infectious Diseases.
Pranita D. Tamma
“I have always assumed that in patients with clinical signs and symptoms related to bacteremia, when both a beta-lactam agent and vancomycin are prescribed, the more important it is to infuse the beta-lactam first.” Pranita D. Tamma, MD, MHS, Director of the Pediatric Antimicrobial Stewardship Program and Associate Professor of Pediatrics at the Johns Hopkins School of Medicine, said Healio.
“This is partly because, based on the numbers, a broad-spectrum beta-lactam is more likely to cover organisms that frequently cause bloodstream infections than is vancomycin, and also, a broad-spectrum beta-lactam is more likely to be active against organisms with the highest levels.” Probability of early mortality, ”said Tamma.
Tamma and colleagues conducted a multicenter observational study of patients 13 years of age and older with bloodstream infections (BSIs) who received both a beta-lactam and vancomycin “to assess the relationship between the order of antibiotic administration” and the mortality rate.
In a related editorial James B. Cutrell, MD, and James M. Sanders, PhD, PharmD, from the University of Texas Southwestern Medical Center, called the study design “elegant”.
“Given the observational study design, they used an inverse treatment weighting probability (IPTW) based on propensity scores using key demographics, comorbidity, disease severity, and treatment variables to offset selection bias,” write Cutrell and Sanders. “They then used weighted regression analysis to estimate the odds ratio of mortality in the IPTW cohort and a doubly robust estimate to compensate for additional potential confounders.”
Of 3,376 patients included in the study, 2,685 (79.5%) received a beta-lactam and 691 (20.5%) vancomycin as the first antibiotic. According to the study, exposed and non-exposed patients in the weighted cohort were similar for all baseline variables.
The study showed that administration of a beta-lactam drug before vancomycin reduced 7-day mortality by 52% (adjusted OR = 0.48; 95% CI 0.33-0.69) and 48-hour mortality Mortality around 55% (aOR = 0.45; 95%, CI 0.24-0.83).
In addition, in a subgroup of more than 500 patients with MRSA-BSI, administration of vancomycin before a beta-lactam was not associated with improved survival (aOR = 0.93; 95% CI 0.33-2.63).
“Our study suggests that when presenting to a seriously ill patient who may be suffering from a bloodstream infection, it is advisable to administer the beta-lactam agent first if both active ingredients are clinically indicated and cannot be administered at the same time,” said Tamma. “This simple change in practice has the potential to improve the chances of survival.”
References:
Amoah J. et al. Clin Infect Dis. 2021; doi: 10.1093 / cid / ciab865.
Cutrell JB and Sanders JM. Clin Infect Dis. 2021; doi: 10.1093 / cid / ciab871.
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