Clinical Outcomes in Patients With Gram-Negative Infections Treated With Optimized Dosing Cefepime Over Various Minimum Inhibitory Concentrations.
J Pharm Pract
; 31(1): 34-39, 2018 Feb.
Article
em En
| MEDLINE
| ID: mdl-29278990
ABSTRACT
BACKGROUND:
The Clinical and Laboratory Standards Institute (CLSI) revised cefepime interpretive criteria, introducing the susceptible dose-dependent category for Enterobacteriaceae with a minimum inhibitory concentration (MIC) of 4 to 8 µg/mL in 2014. Limited clinical data support these new categories. This study compares outcomes of patients treated with standard and high-dose cefepime across various MICs.METHODS:
We retrospectively reviewed cases of pneumonia or bacteremia caused by gram-negative organisms treated with adequate doses of cefepime for ≥48 hours. Outcomes were compared for MICs of ≤2 (low), 4 (medium), and 8 µg/mL (high). The primary end point was clinical failure, the secondary end point was microbiological failure.RESULTS:
Ninety cases met the inclusion criteria 46, 25, and 19 patients with low, medium, or high MIC, respectively. Multivariate logistic regression revealed that the medium (odds ratio [OR] 9.13, P < .01) and high (OR 6.79, P = .01) MIC groups had increased clinical failure.CONCLUSION:
Cefepime therapy, even at CLSI-recommended doses, had an increased risk of clinical failure for gram-negative pathogens with MICs of 4 or 8 µg/mL. This finding suggests that higher dosing regimens (2 g every 8 hours or 1 g every 6 hours) may be necessary to treat serious gram-negative infections with elevated MICs.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Cefalosporinas
/
Infecções por Enterobacteriaceae
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Antibacterianos
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article