Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St, Porto Alegre 90.035-903, Brazil.
Laboratório de Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
J Antimicrob Chemother. 2014 Jun;69(6):1681-7. doi: 10.1093/jac/dku001. Epub 2014 Jan 27.
There are controversies regarding the association of cefepime therapy with increased mortality among patients with infections caused by Gram-negative bacteria (GNB). We evaluated the effect of cefepime on the mortality of patients with GNB bloodstream infections (BSIs).
A prospective cohort study was conducted in adult patients with creatinine ≤1.5 mg/dL who received empirical therapy with cefepime for at least 48 h for BSIs caused by GNB. The outcome was hospital mortality. Potential clinical predictors, including a high-dose regimen (2 g every 8 h), were assessed.
One hundred and thirteen patients were included. Most (78.8%) isolates had low cefepime MICs (≤0.25 mg/L). The overall hospital mortality was 35.4% [25.6% (10/39) and 40.5% (30/74) in patients receiving high-dose and usual-dose cefepime, respectively (P = 0.17)]. In a Cox regression model adjusted for cefepime MIC and propensity score, a high-dose regimen was independently associated with lower mortality rates [adjusted hazard ratio (aHR) 0.41; 95% CI 0.18-0.91; P = 0.029] while presentation with severe sepsis or septic shock was independently associated with higher mortality rates (aHR 4.10; 95% CI 1.78-9.40; P = 0.001). A trend to lower mortality rates was also found in the subgroup analysis of patients who had not switched antibiotic during therapy after adjustment for the latter variables.
High-dose cefepime therapy was associated with lower mortality rates in patients with GNB BSIs, even for GNB with low cefepime MICs.
头孢吡肟治疗革兰氏阴性菌（GNB）感染引起的患者的死亡率增加存在争议。我们评估了头孢吡肟对 GNB 血流感染（BSI）患者死亡率的影响。
对肌酐≤1.5mg/dL 的成年患者进行前瞻性队列研究，这些患者接受了至少 48 小时的头孢吡肟经验性治疗，用于治疗由 GNB 引起的 BSI。主要结局为院内死亡率。评估了潜在的临床预测因素，包括高剂量方案（每 8 小时 2g）。
共纳入 113 例患者。大多数（78.8%）分离株的头孢吡肟 MIC 较低（≤0.25mg/L）。总的院内死亡率为 35.4%[高剂量组和常规剂量组分别为 25.6%（10/39）和 40.5%（30/74），P=0.17]。在调整了头孢吡肟 MIC 和倾向评分的 Cox 回归模型中，高剂量方案与较低的死亡率独立相关[校正后危险比（aHR）0.41；95%CI 0.18-0.91；P=0.029]，而严重脓毒症或感染性休克的表现与较高的死亡率独立相关[aHR 4.10；95%CI 1.78-9.40；P=0.001]。在调整了上述变量后，在未在治疗过程中更换抗生素的患者亚组分析中，也发现了死亡率降低的趋势。
即使对头孢吡肟 MIC 较低的 GNB 患者，高剂量头孢吡肟治疗与较低的死亡率相关。
