Ku Nam Su, Chung Hae-Sun, Choi Jun Yong, Yong Dongeun, Lee Kyungwon, Kim June Myung, Chong Yunsop
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
Biomed Res Int. 2015;2015:831074. doi: 10.1155/2015/831074. Epub 2015 Feb 22.
We investigated the clinical usefulness of the revised 2010 Clinical and Laboratory Standards Institute (CLSI) breakpoints for Escherichia coli and Klebsiella spp. Of 2,623 patients with bacteremia caused by E. coli or Klebsiella spp., 573 who had been treated appropriately with cephalosporin based on the CLSI 2009 guidelines were enrolled. There were no differences in the rates of treatment failure or mortality between the appropriately and inappropriately treated groups according to the CLSI 2010 guidelines. Additionally, in the matched case-control analysis, the treatment failure rate was higher in bacteremic patients with extended-spectrum β-lactamase- (ESBL-) producing but cephalosporin-susceptible organisms than in those with ESBL-nonproducing isolates when patients with urinary tract infections were excluded (44% and 0%, resp., P = 0.026). In patients with bacteremia caused by E. coli or Klebsiella spp., the revised CLSI 2010 guidelines did not lead to poorer outcomes. However, ESBL production appeared to be associated with poor clinical outcomes in patients with bacteremia from sources other than the urinary tract.
我们研究了2010年修订的美国临床和实验室标准协会（CLSI）针对大肠杆菌和克雷伯菌属的折点标准的临床实用性。在2623例由大肠杆菌或克雷伯菌属引起菌血症的患者中，纳入了573例根据CLSI 2009指南接受头孢菌素适当治疗的患者。根据CLSI 2010指南，适当治疗组和不适当治疗组之间的治疗失败率或死亡率没有差异。此外，在配对病例对照分析中，排除尿路感染患者后，产超广谱β-内酰胺酶（ESBL）但对头孢菌素敏感的菌血症患者的治疗失败率高于不产ESBL分离株的患者（分别为44%和0%，P = 0.026）。对于由大肠杆菌或克雷伯菌属引起菌血症的患者，2010年修订的CLSI指南并未导致更差的结果。然而，ESBL的产生似乎与非尿路感染来源的菌血症患者的不良临床结局相关。
