Methods: This retrospective cohort included inpatient adults ≥18 years treated with FEP monotherapy for ≥72 hours (h) between July 2015 to July 2017. Exclusion criteria were source control not achieved within 72h and polymicrobial infections requiring > 1 antibiotic for definitive therapy. Additional data collected were demographics, comorbid conditions, laboratory markers, site of infection, and microbiology. The primary endpoint was clinical treatment failure, defined as change in definitive therapy at >72h due to clinical worsening, leukocytosis (WBC > 10x109/L) for >72h after treatment initiation, fever (single temperature >100.9°F) after >72h of treatment initiation, or readmission within 30 days due to re-infection. Secondary outcomes were 30-day inpatient all-cause mortality and 30-day readmission.
Results: One hundred fourteen subjects were included (58 OB; 56 NOB). Median (IQR) age 58[46-66] years; 66(58%) males. Median [IQR] weight 107[95-124] kg OB patients; 75[63-84] kg NOB patients. Median Charlson score was 3[2-5] (p=0.478). 62% OB patients vs 46% NOB patients experienced a respiratory infection (p=0.094); 28% OB patients vs 39% NOB patients experienced a urinary tract infection (p=0.185). 62% OB patients and 59% NOB patients received FEP 1g q8h (p=0.732). Most common minimum inhibitory concentration (MIC) in both groups was 1 mg/L (74% OB vs 83% NOB; p=0.289). Clinical failure occurred in 52% (67% OB vs 36% NOB; p=0.001). OB patients more likely to need a second antibiotic (31% vs 14%; p=0.033) and have persistent leukocytosis (50% vs 30%; p=0.033). Inpatient all-cause mortality occurred in 17% (22% OB vs 12% NOB; p=0.164). 72% of patients were not readmitted within 30 days of discharge.
Conclusion: OB patients experienced higher treatment failure than NOB patients. Further examination is needed to assess impact of FEP dose and organism MIC on clinical failure in OB patients.
J. L. Wagner,
J. T. Loper, None
K. E. Barber, None
K. R. Stover, None