Zohar Iris, Ben David Debby, Schwartz Orna, Pomerantz Adam, Caliari Gabriel, Hoffman Elinoar, Maor Yasmin
Infectious Disease Unit, Edith Wolfson Medical Center, Holon, Israel.
Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
J Antimicrob Chemother. 2024 Dec 2;79(12):3204-3209. doi: 10.1093/jac/dkae343.
Recently, breakpoints of Enterobacterales to amikacin were changed from MIC ≤ 16 mg/L to MIC ≤ 4 mg/L based mainly on laboratory data with little supporting clinical evidence. Our aim was to investigate the relation between MIC of Enterobacterales to amikacin and mortality among patients with Enterobacterales bacteraemia from a urinary tract source treated with amikacin.
This retrospective, single-centre study included patients with Enterobacterales urinary source bacteraemia treated with amikacin, with Low (MIC ≤ 4 mg/L) and High (MIC 8 or 16 mg/L) MICs. A cohort of patients treated with ertapenem was used to assess if amikacin MIC is a marker of severity independent of antimicrobial treatment. The primary outcome was 30-day mortality. Multivariate logistic regression analysis was done to assess risk factors for mortality.
We included 85 patients, 46 (54.1%) were male, and mean age was 79.0 years (SD 11.7). Sixty-one patients (71.8%) had Low MIC and 24 (28.2%) had High MIC. Thirty-day mortality was 8.2% and 29.2% in the Low and High MIC groups, respectively (P = 0.031). Risk factors for 30-day mortality were age, infection by Enterobacterales other than Escherichia coli and high amikacin MIC. In a cohort of 88 patients treated with ertapenem, amikacin MIC was not associated with 30-day mortality.
We demonstrated a relation between higher amikacin MIC levels (8 and 16 mg/L) and increased 30-day mortality in patients treated with amikacin for bacteraemia secondary to a urinary source. These findings support the new CLSI breakpoint change of Enterobacterales to amikacin.
最近，肠杆菌科细菌对阿米卡星的折点主要根据实验室数据从 MIC≤16 mg/L 改为 MIC≤4 mg/L，几乎没有临床证据支持。我们的目的是研究肠杆菌科细菌对阿米卡星的 MIC 与接受阿米卡星治疗的尿路源性肠杆菌科细菌血症患者死亡率之间的关系。
这项回顾性单中心研究纳入了接受阿米卡星治疗的尿路源性肠杆菌科细菌血症患者，分为低 MIC（MIC≤4 mg/L）和高 MIC（MIC 为 8 或 16 mg/L）组。一组接受厄他培南治疗的患者用于评估阿米卡星 MIC 是否是独立于抗菌治疗的严重程度标志物。主要结局是 30 天死亡率。进行多因素逻辑回归分析以评估死亡风险因素。
我们纳入了 85 例患者，46 例（54.1%）为男性，平均年龄为 79.0 岁（标准差 11.7）。61 例（71.8%）患者 MIC 低，24 例（28.2%）患者 MIC 高。低 MIC 组和高 MIC 组的 30 天死亡率分别为 8.2%和 29.2%（P = 0.031）。30 天死亡率的风险因素包括年龄、非大肠埃希菌的肠杆菌科细菌感染和高阿米卡星 MIC。在一组 88 例接受厄他培南治疗的患者中，阿米卡星 MIC 与 30 天死亡率无关。
我们证明了较高的阿米卡星 MIC 水平（8 和 16 mg/L）与接受阿米卡星治疗的尿路源性菌血症患者 30 天死亡率增加之间存在关联。这些发现支持了临床和实验室标准协会（CLSI）对肠杆菌科细菌阿米卡星折点的新变化。
