By: Christen Arena, PharmD
Dr. Jessica Mulbah is an Infectious Diseases Clinical Pharmacy Specialist at Virtua Health in New Jersey. She completed her PGY-1 residency at Temple University Hospital, Philadelphia, PA and her PGY-2 in at Henry Ford Hospital, Detroit, MI – Infectious Diseases. Her interests include Gram-negative infections, Antimicrobial resistance, HIV/AIDS, and Infectious disease and social determinants of health.
New research published in Diagnostic Microbiology and Infectious Disease!
The study evaluated ceftriaxone as a treatment for bloodstream infections (BSI) caused by low-risk AmpC-producing Enterobacterales, compared to AmpC-stable therapies. Conducted from January 2017 to February 2024, the retrospective cohort included 163 hospitalized patients. Results showed no significant differences in 30-day all-cause mortality (9.3% for ceftriaxone vs. 10.1% for AmpC-stable therapies) or clinical failure rates. Ceftriaxone resistance was only found in AmpC-stable patients. Overall, ceftriaxone demonstrated comparable outcomes, supporting its use for low-risk AmpC infections.
Questions:
What led your group to investigate your project?
In 2022, Henry Ford implemented an AmpC stewardship intervention to promote ceftriaxone use for low or no-risk AmpC organisms, moving away from previously recommended broad-spectrum therapies. The study yielded promising results, demonstrating an increase in ceftriaxone prescribing without significant differences in patient outcomes for infections caused by Serratia marcescens, Morganella morganii, and Providencia spp. Our study builds on this previous research, aimed to further investigate the outcomes of patients with bloodstream infections.
Did any of the findings surprise you?
Not at all.
How have the results of your study impacted your management of AmpC?
The results of this study, along with others, have significantly bolstered my confidence in using ceftriaxone for treating AmpC-producing organisms. During my infectious disease course in pharmacy school, we were taught that treatment options for these organisms were limited to cefepime and carbapenems. Contributing to the literature that could potentially influence future practice is an incredibly rewarding experience.
Based on your research, what are some unanswered questions that you believe should be further investigated?
Given that this was a retrospective study with a relatively small patient cohort, I believe it would be beneficial to replicate this research in a larger, prospective study. This approach could provide more robust data and help clarify any potential differences in outcomes.
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