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Clinical Outcomes in Patients With Gram-Negative Infections Treated With Optimized Dosing Cefepime Over Various Minimum Inhibitory Concentrations.
Altshuler, Jerry; Guervil, David J; Ericsson, Charles D; Wanger, Audrey; Aitken, Samuel L; Ostrosky-Zeichner, Luis.
Afiliação
  • Altshuler J; 1 Pharmacy Department, Mount Sinai Beth Israel, New York, NY, USA.
  • Guervil DJ; 2 Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, TX, USA.
  • Ericsson CD; 3 Division of Infectious Diseases, University of Texas Health Science Center at Houston, Houston, TX, USA.
  • Wanger A; 4 Department of Pathology, University of Texas Health Science Center at Houston, Houston, TX, USA.
  • Aitken SL; 5 Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Ostrosky-Zeichner L; 6 Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, TX, USA.
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.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cefalosporinas / Infecções por Enterobacteriaceae / Antibacterianos Idioma: En Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cefalosporinas / Infecções por Enterobacteriaceae / Antibacterianos Idioma: En Ano de publicação: 2018 Tipo de documento: Article