OBJECTIVE: This study aimed to associate the clinical outcomes of patients with bacteremia with the minimal inhibitory concentrations (MICs) of CPZ/SUL against the causative K. pneumoniae isolates.
METHODS: This multicenter, retrospective study was conducted in Taiwan between July 2017 and April 2021. Patients with K. pneumoniae bacteremia treated with CPZ/SUL were enrolled in this study. CPZ/SUL MICs were determined using the agar dilution method. Data on the patients\' clinical outcomes and characteristics were collected and analyzed.
RESULTS: In total, 201 patients were enrolled. Among the causative K. pneumoniae isolates, 180 (89.5%) were susceptible to CPZ/SUL. Most patients (n = 156, 77.6%) had favorable outcomes. The 30-day mortality rate was 11.9% (n = 24). Multivariate risk analyses showed that higher APACHE II score (Odds Ratio [OR], 1.14; Confidence Interval [CI], 1.07-1.21; p < 0.001), metastatic tumors (OR, 5.76; CI, 2.31-14.40; p < 0.001), and causative K. pneumoniae CPZ/SUL MICs > 16 µg/ml (OR, 4.30; CI, 1.50-12.27; p = 0.006) were independently associated with unfavorable outcomes.
CONCLUSIONS: Patients with K. pneumoniae bacteremia treated with CPZ/SUL at a ratio 1:1 had favorable outcomes when the CPZ/SUL MICs were ≤ 16 µg/ml. Patients with higher APACHE II scores and metastatic tumors had unfavorable outcomes.
目的:本研究旨在将菌血症患者的临床结局与CPZ/SUL对肺炎克雷伯菌的最低抑制浓度(MIC)联系起来。
方法:这个多中心,回顾性研究于2017年7月至2021年4月在台湾进行.接受CPZ/SUL治疗的肺炎克雷伯菌菌血症患者纳入本研究。使用琼脂稀释法测定CPZ/SULMIC。收集并分析患者的临床结果和特征数据。
结果:总计,共纳入201例患者。在致病肺炎克雷伯菌分离物中,180例(89.5%)易感CPZ/SUL。大多数患者(n=156,77.6%)具有良好的预后。30天死亡率为11.9%(n=24)。多变量风险分析表明,较高的APACHEII评分(赔率比[OR],1.14;置信区间[CI],1.07-1.21;p<0.001),转移性肿瘤(OR,5.76;CI,2.31-14.40;p<0.001),和致病性肺炎克雷伯菌CPZ/SULMIC>16µg/ml(OR,4.30;CI,1.50-12.27;p=0.006)与不良结局独立相关。
结论:当CPZ/SULMIC≤16µg/ml时,CPZ/SUL比例为1:1的肺炎克雷伯菌菌血症患者具有良好的结局。具有较高APACHEII评分和转移性肿瘤的患者具有不利的结果。