Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Antimicrob Agents Chemother. 2017 Aug 24;61(9). doi: 10.1128/AAC.00661-17. Print 2017 Sep.
The Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) offer different recommendations for carbapenem MIC susceptibility breakpoints for species. In addition, the clinical efficacy of the intermediate category remains uncertain. This study was designed to determine the optimal predictive breakpoints based on the survival of patients with bacteremia treated with a carbapenem. We analyzed the 30-day mortality rates of 224 adults who received initial carbapenem monotherapy for the treatment of bacteremia at 4 medical centers over a 5-year period, according to the carbapenem MICs of the initial isolates. The 30-day mortality was about 2-fold greater in patients whose isolates had carbapenem MICs of ≥8 mg/liter than in those with isolates with MICs of ≤4 mg/liter. The differences were significant by bivariate analysis (53.1% [60/113] versus 25.2% [28/111], respectively; < 0.001) and on survival analysis by the log rank test ( < 0.001). Classification and regression tree analysis revealed a split between MICs of 4 and 8 mg/liter and predicted the same difference in mortality, with a value of <0.001. Carbapenem treatment for bacteremia caused by isolates with carbapenem MICs of ≥8 mg/liter was an independent predictor of 30-day mortality (odds ratio, 4.218; 95% confidence interval, 2.213 to 8.039; < 0.001). This study revealed that patients with bacteremia treated with a carbapenem had a more favorable outcome when the carbapenem MICs of their isolates were ≤4 mg/liter than those with MICs of ≥8 mg/liter.
临床和实验室标准协会（CLSI）和抗菌药物敏感性试验欧洲委员会（EUCAST）为 种提供了不同的碳青霉烯类药物 MIC 药敏折点建议。此外，中介类别药物的临床疗效仍不确定。本研究旨在根据接受碳青霉烯类药物治疗的 菌血症患者的生存情况，确定最佳预测折点。我们分析了 5 年内 4 家医疗中心 224 例成人初始碳青霉烯类单药治疗 菌血症患者的 30 天死亡率，根据初始分离株的碳青霉烯类 MIC 值进行分组。分离株碳青霉烯类 MIC 值≥8mg/L 的患者 30 天死亡率约为分离株 MIC 值≤4mg/L 的患者的 2 倍（分别为 53.1%[60/113]和 25.2%[28/111]；<0.001），二分类分析差异有统计学意义（<0.001），对数秩检验生存分析差异也有统计学意义（<0.001）。分类和回归树分析显示，MIC 值在 4 和 8mg/L 之间存在差异，且对死亡率的预测也存在相同的差异，<0.001。碳青霉烯类药物治疗分离株 MIC 值≥8mg/L 的 菌血症是 30 天死亡率的独立预测因素（比值比，4.218；95%置信区间，2.213 至 8.039；<0.001）。本研究表明，与 MIC 值≥8mg/L 的分离株相比，碳青霉烯类药物治疗的 菌血症患者分离株 MIC 值≤4mg/L 时的预后更好。
