Chastain Daniel B, Ngando Ijang, Bland Christopher M, Franco-Paredes Carlos, Hawkins W Anthony
University of Georgia College of Pharmacy, 1000 Jefferson Street, Albany, GA, 31701, USA.
Phoebe Putney Memorial Hospital, Albany, GA, 31701, USA.
Ann Clin Microbiol Antimicrob. 2017 May 30;16(1):43. doi: 10.1186/s12941-017-0217-x.
Enterobacteriaceae, which include Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis, are identified as the infectious etiology in the majority of urinary tract infections (UTIs) in community hospitals across the United States. The minimum inhibitory concentration (MIC) is a useful tool when choosing an appropriate antibacterial agent. Recent changes to the 2014 Clinical and Laboratory Standards Institute (CLSI) guidelines included reporting a urine-specific cefazolin breakpoint for enterobacteriaceae (susceptible ≤16 mcg/mL). The purpose of this study was to determine the clinical and financial impact of implementing the 2014 CLSI urine-specific breakpoints for cefazolin in a community-based teaching hospital in the Southern U.S.A.
A retrospective review of patients hospitalized from January 1, 2010 through October 1, 2014 was performed. Patients that met inclusion criteria had a documented initial clinical isolate of E. coli, K. pneumoniae, or P. mirabilis from urine cultures during each year. Descriptive statistics and two-proportion test of hypothesis were used in the analysis to compare susceptibility rates before and after implementation of the updated CLSI breakpoints for cefazolin.
A total of 190 clinical isolates from patients were included in the study. E. coli was the most common organism isolated (63.7%), followed by K. pneumoniae (22.1%), and P. mirabilis (14.2%). 86% of the included isolates were susceptible to cefazolin using the 2010 breakpoints. Implementation of the 2014 breakpoints did not significantly impact susceptibility results for E. coli, K. pneumoniae, or P. mirabilis.
Modification of breakpoints did not significantly impact susceptibility rates of cefazolin. Substituting cefazolin may decrease the overall drug cost by 77.5%. More data is needed to correlate in vitro findings with clinical outcomes using cefazolin for UTIs.
肠杆菌科细菌，包括大肠杆菌、肺炎克雷伯菌和奇异变形杆菌，被确定为美国各地社区医院大多数尿路感染（UTI）的感染病因。最低抑菌浓度（MIC）是选择合适抗菌药物时的一个有用工具。2014年临床和实验室标准协会（CLSI）指南的最新变化包括报告肠杆菌科细菌的尿液特异性头孢唑林断点（敏感≤16 mcg/mL）。本研究的目的是确定在美国南部一家社区教学医院实施2014年CLSI尿液特异性头孢唑林断点的临床和财务影响。
对2010年1月1日至2014年10月1日住院的患者进行回顾性研究。符合纳入标准的患者每年尿培养中有记录的初始临床分离株为大肠杆菌、肺炎克雷伯菌或奇异变形杆菌。分析中使用描述性统计和双比例假设检验来比较实施更新后的CLSI头孢唑林断点前后的药敏率。
该研究共纳入了190例患者的临床分离株。分离出的最常见病原体是大肠杆菌（63.7%），其次是肺炎克雷伯菌（22.1%）和奇异变形杆菌（14.2%）。使用2010年断点，86%的纳入分离株对头孢唑林敏感。2014年断点的实施对大肠杆菌、肺炎克雷伯菌或奇异变形杆菌的药敏结果没有显著影响。
断点的修改对头孢唑林的药敏率没有显著影响。改用头孢唑林可能会使总体药物成本降低77.5%。需要更多数据来将体外研究结果与使用头孢唑林治疗UTI的临床结果相关联。
