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Abstract：
BACKGROUND: Infections caused by Klebsiella pneumoniae are common and result in high mortality rates. In vitro studies demonstrated the potency of cefoperazone/sulbactam (CPZ/SUL) against Klebsiella pneumoniae. However, the clinical efficacy of CPZ/SUL for the treatment of K. pneumoniae bacteremia has not been studied.
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.
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.
摘要：
背景：肺炎克雷伯菌引起的感染很常见，并导致高死亡率。体外研究表明头孢哌酮/舒巴坦（CPZ/SUL）对肺炎克雷伯菌的效力。然而,CPZ/SUL治疗肺炎克雷伯菌菌血症的临床疗效尚未研究.
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。
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。
