Lin Shang-Yi, Lu Po-Liang, Wu Ting-Shu, Shie Shian-Sen, Chang Feng-Yee, Yang Ya-Sung, Chiang Tsung-Ta, Wang Fu-Der, Ho Mao-Wang, Chou Chia-Hui, Liu Jien-Wei, Shi Zhi-Yuan, Chuang Yin-Ching, Tang Hung-Jen
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Infect Dis Ther. 2022 Oct;11(5):1853-1867. doi: 10.1007/s40121-022-00672-2. Epub 2022 Jul 22.
The clinical efficiency of cefoperazone/sulbactam (CPZ/SUL) against Escherichia coli bacteremia was unknown. This study aimed to explore the relationship between CPZ/SUL MIC values and clinical outcomes in Escherichia coli bacteremia.
A multicenter, retrospective, observational cohort study was conducted in Taiwan between January 2015 and December 2020. Patients treated with CPZ/SUL for E. coli bacteremia were enrolled in the analysis. The CPZ/SUL MICs were determined by using the agar dilution method. The primary outcome was 30-day mortality.
Among 247 isolates, 160 (64.8%) isolates were susceptible, 8 (3.2%) were intermediate, and 79 (32.0%) were resistant to cefoperazone. The activity of cefoperazone against cefoperazone-non-susceptible E. coli (n = 87) was restored upon combination with sulbactam, with susceptibility ranging from 0% to 97.7%. The 30-day mortality was 4.5% (11/247) and overall clinical success rate was 91.9% (227/247). Multivariate Cox proportional-hazards model revealed that heart failure [adjusted relative risk (ARR), 5.49; 95% confidence interval (CI) 1.31-23.02; p = 0.020], malignancy (ARR 7.50; 95% CI 2.02-27.80; p = 0.003), SOFA score (ARR 1.29; 95% CI 1.09-1.52; p = 0.003), and CPZ/SUL MIC ≥ 64 mg/L (ARR 11.31; 95% CI 1.34-95.52; p = 0.026) were independently associated with 30-day mortality. No statistically significant differences in 30-day mortality were found between groups with or without cefoperazone susceptibility (3.4% vs. 5.0%, p = 0.751, respectively).
Patients with E. coli bacteremia who were treated with CPZ/SUL had a favorable outcome when the MICs of the isolates were ≤ 16 mg/L and a high risk of mortality with MICs ≥ 64 mg/L.
头孢哌酮/舒巴坦（CPZ/SUL）治疗大肠埃希菌血症的临床疗效尚不清楚。本研究旨在探讨CPZ/SUL的最低抑菌浓度（MIC）值与大肠埃希菌血症临床结局之间的关系。
2015年1月至2020年12月在台湾进行了一项多中心、回顾性、观察性队列研究。纳入接受CPZ/SUL治疗大肠埃希菌血症的患者进行分析。采用琼脂稀释法测定CPZ/SUL的MIC。主要结局为30天死亡率。
在247株分离株中，160株（64.8%）对头孢哌酮敏感，8株（3.2%）中介，79株（32.0%）耐药。头孢哌酮与舒巴坦联合使用后，对头孢哌酮不敏感的大肠埃希菌（n = 87）的活性恢复，敏感率范围为0%至97.7%。30天死亡率为4.5%（11/247），总体临床成功率为91.9%（227/247）。多变量Cox比例风险模型显示，心力衰竭[调整后相对风险（ARR），5.49；95%置信区间（CI）1.31 - 23.02；p = 0.020]、恶性肿瘤（ARR 7.50；95% CI 2.02 - 27.80；p = 0.003）、序贯器官衰竭评估（SOFA）评分（ARR 1.29；95% CI 1.09 - 1.52；p = 0.003）以及CPZ/SUL MIC≥64 mg/L（ARR 11.31；95% CI 1.34 - 95.52；p = 0.026）与30天死亡率独立相关。头孢哌酮敏感组和不敏感组之间30天死亡率无统计学显著差异（分别为3.4%和5.0%，p = 0.751）。
接受CPZ/SUL治疗的大肠埃希菌血症患者，当分离株的MIC≤16 mg/L时预后良好，而当MIC≥64 mg/L时死亡风险高。
