摘要
A new category of cefepime susceptibility, susceptible dose dependent (SDD), for Enterobacteriaceae, has been suggested to maximize its clinical use. However, clinical evidence supporting such a therapeutic strategy is limited. A retrospective study of 305 adults with monomicrobial Enterobacter cloacae bacteremia at a medical center from 2008 to 2012 was conducted. The patients definitively treated with in vitro active cefepime (cases) were compared with those treated with a carbapenem (controls) to assess therapeutic effectiveness. The 30-day crude mortality rate is the primary endpoint, and clinical prognostic factors are assessed. Of 144 patients receiving definitive cefepime or carbapenem therapy, there were no significant differences in terms of age, sex, comorbidity, source of bacteremia, disease severity, or 30-day mortality (26.4% versus 22.2%; P=0.7) among those treated with cefepime (n=72) or a carbapenem (n=72). In the multivariate analysis, the presence of critical illness, rapidly fatal underlying disease, extended-spectrum beta-lactamase (ESBL) producers, and cefepime-SDD (cefepime MIC, 4 to 8 μg/ml) isolates was independently associated with 30-day mortality. Moreover, those infected by cefepime-SDD isolates with definitive cefepime therapy had a higher mortality rate than those treated with a carbapenem (5/7 [71.4%], versus 2/11 [18.2%]; P=0.045). Cefepime is one of the therapeutic alternatives for cefepime-susceptible E. cloacae bacteremia but is inefficient for cases of cefepime-SDD E. cloacae bacteremia compared with carbapenem therapy.
| 原文 | English |
|---|---|
| 頁（從 - 到） | 7558-7563 |
| 頁數 | 6 |
| 期刊 | Antimicrobial agents and chemotherapy |
| 卷 | 59 |
| 發行號 | 12 |
| DOIs | |
| 出版狀態 | Published - 2015 十二月 1 |
指紋
All Science Journal Classification (ASJC) codes
- Pharmacology
- Pharmacology (medical)
- Infectious Diseases
引用此文
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Cefepime therapy for monomicrobial Enterobacter cloacae bacteremia : Unfavorable outcomes in patients infected by cefepime-susceptible dose-dependent isolates. / Lee, Nan Yao; Lee, Ching Chi; Li, Chia Wen; Li, Ming Chi; Chen, Po Lin; Chang, Chia Ming; Ko, Wen Chien.
於: Antimicrobial agents and chemotherapy, 卷 59, 編號 12, 01.12.2015, p. 7558-7563.研究成果: Article
TY - JOUR
T1 - Cefepime therapy for monomicrobial Enterobacter cloacae bacteremia
T2 - Unfavorable outcomes in patients infected by cefepime-susceptible dose-dependent isolates
AU - Lee, Nan Yao
AU - Lee, Ching Chi
AU - Li, Chia Wen
AU - Li, Ming Chi
AU - Chen, Po Lin
AU - Chang, Chia Ming
AU - Ko, Wen Chien
PY - 2015/12/1
Y1 - 2015/12/1
N2 - A new category of cefepime susceptibility, susceptible dose dependent (SDD), for Enterobacteriaceae, has been suggested to maximize its clinical use. However, clinical evidence supporting such a therapeutic strategy is limited. A retrospective study of 305 adults with monomicrobial Enterobacter cloacae bacteremia at a medical center from 2008 to 2012 was conducted. The patients definitively treated with in vitro active cefepime (cases) were compared with those treated with a carbapenem (controls) to assess therapeutic effectiveness. The 30-day crude mortality rate is the primary endpoint, and clinical prognostic factors are assessed. Of 144 patients receiving definitive cefepime or carbapenem therapy, there were no significant differences in terms of age, sex, comorbidity, source of bacteremia, disease severity, or 30-day mortality (26.4% versus 22.2%; P=0.7) among those treated with cefepime (n=72) or a carbapenem (n=72). In the multivariate analysis, the presence of critical illness, rapidly fatal underlying disease, extended-spectrum beta-lactamase (ESBL) producers, and cefepime-SDD (cefepime MIC, 4 to 8 μg/ml) isolates was independently associated with 30-day mortality. Moreover, those infected by cefepime-SDD isolates with definitive cefepime therapy had a higher mortality rate than those treated with a carbapenem (5/7 [71.4%], versus 2/11 [18.2%]; P=0.045). Cefepime is one of the therapeutic alternatives for cefepime-susceptible E. cloacae bacteremia but is inefficient for cases of cefepime-SDD E. cloacae bacteremia compared with carbapenem therapy.
AB - A new category of cefepime susceptibility, susceptible dose dependent (SDD), for Enterobacteriaceae, has been suggested to maximize its clinical use. However, clinical evidence supporting such a therapeutic strategy is limited. A retrospective study of 305 adults with monomicrobial Enterobacter cloacae bacteremia at a medical center from 2008 to 2012 was conducted. The patients definitively treated with in vitro active cefepime (cases) were compared with those treated with a carbapenem (controls) to assess therapeutic effectiveness. The 30-day crude mortality rate is the primary endpoint, and clinical prognostic factors are assessed. Of 144 patients receiving definitive cefepime or carbapenem therapy, there were no significant differences in terms of age, sex, comorbidity, source of bacteremia, disease severity, or 30-day mortality (26.4% versus 22.2%; P=0.7) among those treated with cefepime (n=72) or a carbapenem (n=72). In the multivariate analysis, the presence of critical illness, rapidly fatal underlying disease, extended-spectrum beta-lactamase (ESBL) producers, and cefepime-SDD (cefepime MIC, 4 to 8 μg/ml) isolates was independently associated with 30-day mortality. Moreover, those infected by cefepime-SDD isolates with definitive cefepime therapy had a higher mortality rate than those treated with a carbapenem (5/7 [71.4%], versus 2/11 [18.2%]; P=0.045). Cefepime is one of the therapeutic alternatives for cefepime-susceptible E. cloacae bacteremia but is inefficient for cases of cefepime-SDD E. cloacae bacteremia compared with carbapenem therapy.
UR - http://www.scopus.com/inward/record.url?scp=84954537407&partnerID=8YFLogxK
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U2 - 10.1128/AAC.01477-15
DO - 10.1128/AAC.01477-15
M3 - Article
C2 - 26416853
AN - SCOPUS:84954537407
VL - 59
SP - 7558
EP - 7563
JO - Antimicrobial Agents and Chemotherapy
JF - Antimicrobial Agents and Chemotherapy
SN - 0066-4804
IS - 12
ER -