Clinical outcomes of carbapenem vs. non-carbapenem therapy in hospitalized adults with shigellosis
TL;DR
Susceptibility testing was underutilized and may be essential to guide local empiric and targeted therapy decisions and was associated with significantly longer hospitalization.
Abstract
Abstract Background: Management of shigellosis is increasingly complicated by antimicrobial resistance, yet susceptibility testing is rarely performed, and the role of broad-spectrum empiric therapy in hospitalized adults remains unclear. Methods: We conducted a multi-center retrospective cohort study of adults hospitalized with stool-confirmed Shigella spp. from October 2023 to August 2024 across five hospitals in the Portland metropolitan area. The primary outcome was time from antibiotic initiation to symptom resolution (less than 3 stools in 24 h) and the secondary outcome was length of hospital stay. Results: Of 45 patients included in the outcome analyses, 29 (64%) received carbapenems and 16 (36%) received non-carbapenem antibiotics. Median time from antibiotic initiation to symptom resolution was 18 hours (IQR 9–37) in the carbapenem group and 29 hours (IQR 15–36) in the non-carbapenem group, with no significant difference between groups (P = .89). The median length of hospital stay was significantly longer in the carbapenem group, at 5.4 days (IQR 3.6–8.3), compared with 3.9 days (IQR 2.6–4.4) in the non-carbapenem group (P = .02). Only 26% of patients had susceptibility testing ordered. Conclusions: Carbapenem use was not associated with faster symptom resolution and was associated with significantly longer hospitalization. Susceptibility testing was underutilized and may be essential to guide local empiric and targeted therapy decisions.