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Association between treatment with oral third‐generation cephalosporin antibiotics and mortality outcomes in Ebola virus disease: a multinational retrospective cohort study
Author(s) -
Aluisio Adam R.,
Perera Shiromi M.,
Yam Derrick,
Garbern Stephanie,
Peters Jillian L.,
Abel Logan,
Cho Daniel K.,
Woldemichael Dayan,
Kennedy Stephen B.,
Massaquoi Moses,
Sahr Foday,
Liu Tao,
Levine Adam C.
Publication year - 2020
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13369
Subject(s) - medicine , cefixime , propensity score matching , retrospective cohort study , odds ratio , logistic regression , antibiotics , cephalosporin , biology , microbiology and biotechnology
Objective To evaluate the association between oral third‐generation cephalosporin antibiotic treatment and mortality in Ebola virus disease (EVD). Methods This retrospective cohort studied EVD‐infected patients admitted to five Ebola Treatment Units in Sierra Leone and Liberia during 2014–15. Empiric treatment with cefixime 400 mg once daily for five days was the clinical protocol; however, due to resource variability, only a subset of patients received treatment. Data on sociodemographics, clinical characteristics, malaria status and Ebola viral loads were collected. The primary outcome was mortality compared between cases treated with cefixime within 48 h of admission to those not treated within 48 h. Propensity scores were derived using clinical covariates. Mortality between treated and untreated cases was compared using propensity‐matched conditional logistic regression and bootstrapped log‐linear regression analyses to calculate an odds ratio (OR) and relative risk (RR), respectively, with associated 95% confidence intervals (CI). Results Of 424 cases analysed, 360 (84.9%) met the cefixime treatment definition. The mean age was 30.5 years and 40.3% were male. Median cefixime treatment duration was 4 days (IQR: 3, 5). Among cefixime‐treated patients, mortality was 54.7% (95% CI: 49.6–59.8%) vs . 73.4% (95% CI: 61.5–82.7%) in untreated patients. In conditional logistic regression, mortality likelihood was significantly lower among cases receiving cefixime (OR = 0.48, 95% CI: 0.32–0.71; P = 0.01). In the bootstrap analysis, a non‐significant risk reduction was found with cefixime treatment (RR = 0.82, 95% CI: 0.64–1.16, P = 0.11). Conclusion Early oral cefixime may be associated with reduced mortality in EVD and warrants further investigation.