https://scholars.lib.ntu.edu.tw/handle/123456789/528411
標題: | Cefepime therapy for monomicrobial bacteremia caused by cefepime-susceptible extended-spectrum beta-lactamase-producing enterobacteriaceae: MIC matters | 作者: | Lee N.-Y. Lee C.-C. Huang W.-H. Tsui K.-C. PO-REN HSUEH Ko W.-C. |
公開日期: | 2013 | 卷: | 56 | 期: | 4 | 起(迄)頁: | 488-495 | 來源出版物: | Clinical Infectious Diseases | 摘要: | Background. Extended-spectrum ?-lactamase (ESBL)-producing Enterobacteriaceae isolates are important clinical pathogens. In addition, the efficacy of cefepime for such infections is controversial.Methods. We performed a retrospective study of monomicrobial bacteremia caused by ESBL producers at 2 medical centers between May 2002 and August 2007. The patients definitively treated with in vitro active cefepime (cases) were compared with those treated with a carbapenem (controls) in a propensity score-matched analysis to assess therapeutic effectiveness. The 30-day crude mortality is the primary endpoint.Results. A total of 178 patients were eligible for the study. Patients who received cefepime (n = 17) as definitive therapy were more likely to have a clinical failure (odds ratio [OR] 6.2; 95% confidence interval [CI], 1.7-22.5; P =. 002), microbiological failure (OR 5.5; 95% CI, 1.3-25.6; P =. 04), and 30-day mortality (OR 7.1; 95% CI, 2.5-20.3; P <. 001) than those who received carbapenem therapy (n = 161). Multivariate regression revealed that a critical illness with a Pitt bacteremia score ?4 points (OR 5.4; 95% CI, 1.4-20.9; P =. 016), a rapidly fatal underlying disease (OR 4.4; 95% CI, 1.5-12.6; P =. 006), and definitive cefepime therapy (OR 9.9; 95% CI, 2.8-31.9; P <. 001) were independently associated with 30-day crude mortality. There were 17 case-control pairs in the propensity scores matched analysis. The survival analysis consistently found that individuals who received cefepime therapy had a lower survival rate (log-rank test, P =. 016). Conclusions. Based on the current Clinical and Laboratory Standards Institute susceptible breakpoint of cefepime (minimum inhibitory concentration ?8 μg/mL), cefepime definitive therapy is inferior to carbapenem therapy in treating patients with so-called cefepime-susceptible ESBL-producer bacteremia. ? 2012 The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/528411 | ISSN: | 1058-4838 | DOI: | 10.1093/cid/cis916 | SDG/關鍵字: | carbapenem; cefepime; corticosteroid; ertapenem; extended spectrum beta lactamase; imipenem; meropenem; abdominal infection; adult; aged; antibiotic sensitivity; article; bacteremia; bacterium isolate; catheter infection; clinical evaluation; controlled study; critical illness; disease severity; drug efficacy; drug treatment failure; Enterobacter cloacae; Enterobacteriaceae; Escherichia coli; fatality; female; human; immunosuppressive treatment; Klebsiella pneumoniae; major clinical study; male; minimum inhibitory concentration; monotherapy; mortality; pneumonia; priority journal; propensity score; retrospective study; scoring system; sepsis; skin infection; soft tissue infection; survival rate; university hospital; urosepsis; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Carbapenems; Case-Control Studies; Cephalosporins; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Multivariate Analysis; Retrospective Studies; Treatment Outcome |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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