https://scholars.lib.ntu.edu.tw/handle/123456789/190003
標題: | Carbapenem Therapy for Bacteremia Due to Extended-Spectrum-beta-Lactamase-Producing Escherichia coli or Klebsiella pneumoniae: Implications of Ertapenem Susceptibility | 作者: | Lee, Nan-Yao Lee, Ching-Chi Huang, Wei-Han Tsui, Ko-Chung Hsueh, Po-Ren Ko, Wen-Chien |
公開日期: | 2012 | 卷: | 56 | 期: | 6 | 起(迄)頁: | 2888-2893 | 來源出版物: | Antimicrob. Agents Chemother. | 摘要: | A retrospective study was conducted at two medical centers in Taiwan to evaluate the clinical characteristics, outcomes, and risk factors for mortality among patients treated with a carbapenem for bacteremia caused by extended-spectrum-beta-lactamase (ESBL)-producing organisms. A total of 251 patients with bacteremia caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates treated by a carbapenem were identified. Among these ESBL-producing isolates, rates of susceptibility to ertapenem (MICs <= 0.25 mu g/ml) were 83.8% and 76.4%, respectively; those to meropenem were 100% and 99.3%, respectively; and those to imipenem were 100% and 97.9%, respectively. There were no significant differences in the critical illness rate (P = 0.1) or sepsis-related mortality rate (P = 0.2) for patients with bacteremia caused by ESBL-producing K. pneumoniae (140 isolates, 55.8%) and E. coli (111 isolates, 44.2%). Multivariate analysis of variables related to sepsis-related mortality revealed that the presence of severe sepsis (odds ratio [OR], 15.9; 95% confidence interval [CI], 5.84 to 43.34; P < 0.001), hospital-onset bacteremia (OR, 4.65; 95% CI, 1.42 to 15.24; P = 0.01), and ertapenem-nonsusceptible isolates (OR, 5.12; 95% CI, 2.04 to 12.88; P = 0.001) were independent risk factors. The patients receiving inappropriate therapy had a higher sepsis-related mortality than those with appropriate therapy (P = 0.002), irrespective of ertapenem, imipenem, or meropenem therapy. Infections due to the ertapenem-susceptible isolates (MICs <= 0.25 mu g/ml) were associated with a more favorable outcome than those due to ertapenem-nonsusceptible isolates (MICs > 0.25 mu g/ml), if treated by a carbapenem. However, the mortality for patients with bacteremic episodes due to isolates with MICs of <= 0.5 mu g/ml was similar to the mortality for those whose isolates had MICs of >0.5 mu g/ml (P = 0.8). Such a finding supports the rationale of the current CLSI 2011 criteria for carbapenems for Enterobacteriaceae. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/258881 |
顯示於: | 醫學系 |
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