Source:http://linkedlifedata.com/resource/pubmed/id/17938179
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rdf:type | |
lifeskim:mentions | |
pubmed:issue |
12
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pubmed:dateCreated |
2007-11-20
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pubmed:abstractText |
For commonly encountered gram-negative bacilli, a MIC of cefepime of 8 mug/ml or less was defined by the Clinical and Laboratory Standards Institute as "susceptible" prior to the commercial release of the antibiotic. We assessed 204 episodes of bacteremia caused by gram-negative organisms for which patients received cefepime (typically 1 to 2 g every 12 h) as the primary mode of therapy. The cefepime MIC breakpoint derived by classification and regression tree (CART) software analysis to delineate the risk of 28-day mortality was 8 microg/ml. Patients infected with gram-negative organisms treated with cefepime at a MIC of > or =8 microg/ml had a mortality rate of 54.8% (17/31 died), compared to 24.1% (35/145 died) for those treated with a cefepime MIC of <8 microg/ml. The rate of mortality for those treated with a cefepime MIC of 8 microg/ml was 56.3% (9/16 died), compared to 53.3% (8/15 died) for those treated with cefepime at a MIC of >8 microg/ml. A multivariable analysis including severity of illness indices showed that treating patients with bacteremia due to gram-negative organisms with a cefepime MIC of > or =8 microg/ml was an independent predictor of mortality (P < or = 0.001). There was no significant difference in outcome according to the dosage regimen utilized. Pharmacodynamic assessments that were presented previously would suggest that cefepime treatment (particularly a dosage of 1 g every 12 h) has a low probability of target attainment associated with successful in vivo outcome when the cefepime MIC is > or =8 microg/ml. It would appear reasonable, based on pharmacodynamic and clinical grounds, to lower the breakpoints for cefepime in countries where the cefepime dosage of 1 to 2 g every 12 h is the licensed therapy for serious infections, so that organisms with a cefepime MIC of 8 microg/ml are no longer regarded as susceptible to the antibiotic.
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pubmed:commentsCorrections |
http://linkedlifedata.com/resource/pubmed/commentcorrection/17938179-11236773,
http://linkedlifedata.com/resource/pubmed/commentcorrection/17938179-11376058,
http://linkedlifedata.com/resource/pubmed/commentcorrection/17938179-15831827,
http://linkedlifedata.com/resource/pubmed/commentcorrection/17938179-15983294,
http://linkedlifedata.com/resource/pubmed/commentcorrection/17938179-16029947,
http://linkedlifedata.com/resource/pubmed/commentcorrection/17938179-16223952,
http://linkedlifedata.com/resource/pubmed/commentcorrection/17938179-16267725,
http://linkedlifedata.com/resource/pubmed/commentcorrection/17938179-1959406
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pubmed:language |
eng
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pubmed:journal | |
pubmed:citationSubset |
IM
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pubmed:chemical | |
pubmed:status |
MEDLINE
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pubmed:month |
Dec
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pubmed:issn |
0066-4804
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pubmed:author | |
pubmed:issnType |
Print
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pubmed:volume |
51
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pubmed:owner |
NLM
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pubmed:authorsComplete |
Y
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pubmed:pagination |
4390-5
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pubmed:dateRevised |
2009-11-18
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pubmed:meshHeading |
pubmed-meshheading:17938179-Aged,
pubmed-meshheading:17938179-Anti-Bacterial Agents,
pubmed-meshheading:17938179-Bacteremia,
pubmed-meshheading:17938179-Cephalosporins,
pubmed-meshheading:17938179-Gram-Negative Bacteria,
pubmed-meshheading:17938179-Humans,
pubmed-meshheading:17938179-Microbial Sensitivity Tests,
pubmed-meshheading:17938179-Middle Aged,
pubmed-meshheading:17938179-Multivariate Analysis,
pubmed-meshheading:17938179-Survival Rate,
pubmed-meshheading:17938179-Treatment Outcome
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pubmed:year |
2007
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pubmed:articleTitle |
Failure of current cefepime breakpoints to predict clinical outcomes of bacteremia caused by gram-negative organisms.
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pubmed:affiliation |
Division of Infectious Diseases, University of Pittsburgh Medical Center, Suite 3A Falk Medical Building, 3601 Fifth Avenue, Pittsburgh, PA 15213, USA.
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pubmed:publicationType |
Journal Article
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