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Kim YJ, Kim S, Ham H, Yu S, Choo HJ, Kim HJ, Heo R, Choi G, Kim SH, Lee HJ. Trend of nontuberculous mycobacteria species and minimal inhibitory concentration in a referral laboratory in Korea from 2013 to 2019. J Infect Public Health 2024; 17:212-216. [PMID: 38113818 DOI: 10.1016/j.jiph.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/06/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND This study investigated the trends of nontuberculous mycobacterial (NTM) isolates and the minimal inhibitory concentrations (MIC) of antimicrobial agents in Korea. METHODS Data from 2013 to 2019 were collected from 69 medical institutions through 12 branches of the Korean Institute of Tuberculosis. NTM identification was conducted using the Advansure Mycobacteria Genoblot assay. The MIC of antibiotics against NTM species were measured using the broth microdilution method according to the Clinical and Laboratory Standards Institute guidelines. RESULTS Over seven years, 86,194 NTM identifications were requested, with an annual increase from 8034 in 2013-17,229 in 2019. The most frequently identified NTM species were M. intracellulare (33,467; 47.3%) and M. avium (19,818; 27.2%), followed by M. abscessus (6858; 9.4%) and M. massiliense (3156; 4.3%). Regarding the antimicrobial agents, imipenem exhibited the greatest difference in MIC between M. intracellulare and M. avium, whereas clarithromycin showed the most significant difference between M. abscessus and M. massiliense. No notable changes were observed in the annual MIC distribution of most antibacterial agents, except for clarithromycin in M. abscessus. CONCLUSIONS The prevalence of NTM in Korea is gradually increasing, and follow-up studies on NTM isolates identified as the causative agents of infection are needed.
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Affiliation(s)
- Young Jin Kim
- Department of Laboratory Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Seungmo Kim
- Laboratory Medicine Center, The Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
| | - Heejung Ham
- Department of Laboratory Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Sarah Yu
- College of Health Science, Korea University, Seoul, Republic of Korea
| | - Hyeon-Ju Choo
- Clinical Laboratory Center, Korean National Tuberculosis Association, Seoul, Republic of Korea
| | - Hwi-Jun Kim
- Laboratory Medicine Center, The Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
| | - Ryeun Heo
- Laboratory Medicine Center, The Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
| | - Gyeongsik Choi
- Laboratory Medicine Center, The Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
| | - Soul-Hee Kim
- Laboratory Medicine Center, The Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
| | - Hee Joo Lee
- Clinical Laboratory Center, Korean National Tuberculosis Association, Seoul, Republic of Korea.
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de Jong A, Youala M, Klein U, El Garch F, Moyaert H, Simjee S, Maes D, Gyuranecz M, Pridmore A, Thomson JR, Ayling RD. Antimicrobial susceptibility monitoring of Mycoplasma hyopneumoniae isolated from seven European countries during 2015-2016. Vet Microbiol 2020; 253:108973. [PMID: 33418394 DOI: 10.1016/j.vetmic.2020.108973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
Mycoplasma hyopneumoniae is the causative agent of porcine enzootic pneumonia, a chronic respiratory disease, causing significant economic losses. Results from the 2015-2016 MycoPath pan-European antimicrobial susceptibility monitoring survey of M. hyopneumoniae are presented. In total, 147 M. hyopneumoniae porcine isolates from Belgium, France, Germany, Great Britain, Hungary, Italy, and Spain were tested. One isolate per farm was retained from pigs that had not been recently treated with antimicrobial agents. The minimal inhibitory concentration (MIC) of 13 antimicrobial agents was determined in a central laboratory using a broth microdilution method, with Friis Medium, incubated at 35 ± 1 °C for 5-12 days. M. hyopneumoniae NCTC 10110 was used as Quality Control. MIC50/MIC90 (mg/L) values were: enrofloxacin 0.06/1; marbofloxacin 0.06/2; spiramycin 0.06/0.25; tulathromycin ≤0.001/0.004; gamithromycin 0.06/0.5; tylosin 0.016/0.06; tilmicosin 0.06/0.5; florfenicol 0.5/1; doxycycline 0.25/1; oxytetracycline 0.25/2; lincomycin 0.06/0.25; tiamulin 0.016/0.06 and valnemulin ≤0.001/0.004. Compared with the data from 2010 to 2012 MycoPath study (50 isolates), MIC50/90 results were similar and the majority were within ± two dilution steps, except for the MIC50 of oxytetracycline which is more than two dilution steps higher in the present study. Between-country comparisons show some differences in the MIC values for the fluoroquinolones, tulathromycin and tylosin, but the limited sample size per country precludes performing meaningful country comparisons for several countries. Standardized laboratory methods and interpretive criteria for MIC testing of veterinary mycoplasmas are clearly needed; there are currently no clinical breakpoints available to facilitate data interpretation and correlation of MICs with in vivo efficacy.
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Affiliation(s)
- Anno de Jong
- MycoPath Study Group, c/o CEESA, 168 Av de Tervueren, 1150 Brussels, Belgium; Consultant to CEESA, Brussels, Belgium.
| | - Myriam Youala
- MycoPath Study Group, c/o CEESA, 168 Av de Tervueren, 1150 Brussels, Belgium; Virbac, Carros, France
| | - Ulrich Klein
- MycoPath Study Group, c/o CEESA, 168 Av de Tervueren, 1150 Brussels, Belgium; Elanco Animal Health, Basingstoke, UK
| | - Farid El Garch
- MycoPath Study Group, c/o CEESA, 168 Av de Tervueren, 1150 Brussels, Belgium; Vétoquinol SA, Lure, France
| | - Hilde Moyaert
- MycoPath Study Group, c/o CEESA, 168 Av de Tervueren, 1150 Brussels, Belgium; Zoetis, Zaventem, Belgium
| | - Shabbir Simjee
- MycoPath Study Group, c/o CEESA, 168 Av de Tervueren, 1150 Brussels, Belgium; Elanco Animal Health, Basingstoke, UK
| | - Dominiek Maes
- Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Miklós Gyuranecz
- Institute for Veterinary Medical Research CAR, Budapest, Hungary
| | | | - Jill R Thomson
- Scottish Agriculture College (Consulting) Veterinary Services, Edinburgh, UK
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Baati H, Siala M, Azri C, Ammar E, Dunlap C, Trigui M. Resistance of a Halobacterium salinarum isolate from a solar saltern to cadmium, lead, nickel, zinc, and copper. Antonie Van Leeuwenhoek 2020; 113:1699-711. [PMID: 32974806 DOI: 10.1007/s10482-020-01475-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
The current study focuses on the tolerance of a strain of Halobacterium salinarum isolated from Sfax solar saltern (Tunisia) towards cadmium (Cd), lead (Pb), nickel (Ni), zinc (Zn), and copper (Cu) by using agar dilution methods in complex and minimal media. The results showed the least inhibitory metals based on Minimum Inhibitory Concentrations (MICs) were lead (MIC = 4.5 mM), cadmium (MIC = 4 mM), and nickel (MIC = 2.5 mM) in complex medium. The MICs of these metals were more inhibitory (MIC < 2 mM) in the other tested media. The archaeal strain revealed a high sensitivity for copper and zinc, with MICs below 0.5 mM for both metals. Growth kinetics in complex and minimal media showed the strain to be more sensitive to the metals in liquid media than in solid media. The growth kinetic assays indicated the presence of selected heavy metals resulted in a lower growth rate and lower total cell mass relative to the control. Despite that cadmium and lead are nonessential and have no nutrient value, they were the most tolerated metals by H. salinarum strain. In addition, pigment intensity in the strain was inhibited by the presence of the heavy metals relative to the control.
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Insa S, Alioune F, Aicha BL, Fama NS, Seydou K, Abdoulaye D, Ismaïla C, Abda B, Amadou D, Sadibou BC, Generosa G, Yagamare F, Matar S. Synthesis, Characterization and Antimicrobial Activities of 1,4- Disubstituted 1,2,3-Triazole Compounds. Curr Top Med Chem 2020; 20:2289-2299. [PMID: 32814526 DOI: 10.2174/1568026620666200819143029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND 1,2,3-triazoles are five-membered heterocyclic scaffold; their broad-spectrum biological activities are known. Researchers around the world are increasingly being interested in this emerging area, owing to its immense pharmacological scope. OBJECTIVE This work summarizes the synthesis of 1,2,3-triazoles and the significance of this pattern as a lead structure for new drug molecules discovery. METHODS 1,2,3-triazoles can be obtained on a multigram scale through "click chemistry" under ambient conditions. RESULTS Sixteen compounds were synthesized and evaluated on five microbial strains E. coli, E. faecalis, P. aeruginosa, S. aureus and C. albicans. NMR, MS and IR were used to characterize all compounds. They were evaluated with their Minimum Inhibitory Concentrations (MICs) and interesting results were obtained with compounds 12a, 12b, 3, 2a and 2c, with MIC 0.14 μM (P. aeruginosa), 1.08 μM (E. coli), 1.20 μM (E. faecalis and C. albicans), 3.5 μM (E. faecalis) and 4.24 μM (C. albicans), respectively. P. aeruginosa and C. albicans were the most sensitive among all the strains. CONCLUSION The synthesized compounds were found as potential antimicrobial agents against Gram (+), Gram (-) strains and fungi.
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Affiliation(s)
- Seck Insa
- Laboratoire de Chimie de Coordination Organique (LCCO), Departement de Chimie, Faculte des Sciences et Techniques, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Fall Alioune
- Laboratoire de Chimie de Coordination Organique (LCCO), Departement de Chimie, Faculte des Sciences et Techniques, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Ba Lalla Aicha
- Universite Amadou Mahtar Mbow, Campus de Dakar, Cite Keur-Gorgui, lot 75R VDN, BP 45927 Dakar FANN-VDN. Dakar, Senegal
| | - Ndoye Samba Fama
- Laboratoire de Chimie Organique et Therapeutique, Faculte de Medecine, de Pharmacie et d'Odontologie de l'Universite Cheikh Anta Diop de Dakar, BP 5005, Dakar-Fann, Senegal
| | - Ka Seydou
- Laboratoire de Chimie Organique et Therapeutique, Faculte de Medecine, de Pharmacie et d'Odontologie de l'Universite Cheikh Anta Diop de Dakar, BP 5005, Dakar-Fann, Senegal
| | - Diop Abdoulaye
- Laboratoire Bacteriologie-Virologie, CHU Aristide Le Dantec, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Ciss Ismaïla
- Laboratoire de Chimie Organique et Therapeutique, Faculte de Medecine, de Pharmacie et d'Odontologie de l'Universite Cheikh Anta Diop de Dakar, BP 5005, Dakar-Fann, Senegal
| | - Ba Abda
- Laboratoire de Chimie Organique et Therapeutique, Faculte de Medecine, de Pharmacie et d'Odontologie de l'Universite Cheikh Anta Diop de Dakar, BP 5005, Dakar-Fann, Senegal
| | - Diop Amadou
- Laboratoire Bacteriologie-Virologie, CHU Aristide Le Dantec, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Boye Cheikh Sadibou
- Laboratoire Bacteriologie-Virologie, CHU Aristide Le Dantec, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Gomez Generosa
- Departamento de Quimica Organica, Facultad de Quimica and Instituto de Investigacion Biomedica (IBI), University of Vigo, Campus Lagoas de Marcosende, 36310 Vigo, Spain
| | - Fall Yagamare
- Departamento de Quimica Organica, Facultad de Quimica and Instituto de Investigacion Biomedica (IBI), University of Vigo, Campus Lagoas de Marcosende, 36310 Vigo, Spain
| | - Seck Matar
- Laboratoire de Chimie Organique et Therapeutique, Faculte de Medecine, de Pharmacie et d'Odontologie de l'Universite Cheikh Anta Diop de Dakar, BP 5005, Dakar-Fann, Senegal
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Klein U, de Jong A, Youala M, El Garch F, Stevenin C, Moyaert H, Rose M, Catania S, Gyuranecz M, Pridmore A, Ayling RD. New antimicrobial susceptibility data from monitoring of Mycoplasma bovis isolated in Europe. Vet Microbiol 2019; 238:108432. [PMID: 31648729 DOI: 10.1016/j.vetmic.2019.108432] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/21/2019] [Accepted: 09/26/2019] [Indexed: 12/15/2022]
Abstract
Mycoplasma bovis is an important respiratory pathogen of cattle across Europe and is included in the MycoPath pan-European antimicrobial susceptibility monitoring programme. M. bovis strains (232) were isolated from cattle, not recently treated with antimicrobials, at diverse geographical locations in France, Great Britain, Hungary, Italy and Spain during 2014 to 2016. Only one isolate per farm and per outbreak was retained. For each isolate, the MICs of ten antimicrobials were determined in a central laboratory using a broth microdilution method with modified Eaton's medium and incubation at 35 °C ± 1 °C for 24 ± 6 h. MIC50/MIC90 (mg/L) values for the 232 strains were: danofloxacin 0.25/1; enrofloxacin 0.5/8; marbofloxacin 1/4; gamithromycin >64/>64; spiramycin 8/16; tilmicosin >64/>64; tulathromycin >64/>64; tylosin 64/>64; florfenicol 4/8; oxytetracycline 8/32. Minor between-country differences in the MIC90 values were observed for the fluoroquinolones, spiramycin and oxytetracycline, whilst the MIC values for the other compounds were similar. Spain and Italy had the higher MIC90 values for the fluoroquinolones. Compared with the 2010-2012 study (156 isolates) results are similar, with an overall MIC50 increase of at most one doubling dilution for enrofloxacin, spiramycin, tylosin, florfenicol and oxytetracycline. In contrast, the MIC90 value for oxytetracycline decreased from >64 to 32 mg/L. Standardized laboratory methods and interpretive criteria for MIC testing of veterinary mycoplasmas are clearly needed; there are currently no clinical breakpoints available to facilitate data interpretation and correlation of MICs with in vivo efficacy.
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Affiliation(s)
- Ulrich Klein
- MycoPath Study Group, c/o CEESA, 168 Av de Tervueren, 1150, Brussels, Belgium; Elanco Animal Health, Basingstoke, UK
| | - Anno de Jong
- MycoPath Study Group, c/o CEESA, 168 Av de Tervueren, 1150, Brussels, Belgium; Bayer Animal Health GmbH, Monheim, Germany.
| | - Myriam Youala
- MycoPath Study Group, c/o CEESA, 168 Av de Tervueren, 1150, Brussels, Belgium; Virbac, Carros, France
| | - Farid El Garch
- MycoPath Study Group, c/o CEESA, 168 Av de Tervueren, 1150, Brussels, Belgium; Vetoquinol S.A, Lure, France
| | - Clelia Stevenin
- MycoPath Study Group, c/o CEESA, 168 Av de Tervueren, 1150, Brussels, Belgium; Boehringer Ingelheim Vetmedica, Ingelheim, Germany
| | - Hilde Moyaert
- MycoPath Study Group, c/o CEESA, 168 Av de Tervueren, 1150, Brussels, Belgium; Zoetis, Zaventem, Belgium
| | - Markus Rose
- MycoPath Study Group, c/o CEESA, 168 Av de Tervueren, 1150, Brussels, Belgium; MSD Animal Health Innovation GmbH, Schwabenheim, Germany
| | - Salvatore Catania
- Mycoplasma Unit, Istituto Zooprofilattico Sperimentale delle Venezie, Verona, Italy
| | - Miklós Gyuranecz
- Institute for Veterinary Medical Research CAR-HAS, Budapest, Hungary
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Aono A, Morimoto K, Chikamatsu K, Yamada H, Igarashi Y, Murase Y, Takaki A, Mitarai S. Antimicrobial susceptibility testing of Mycobacteroides (Mycobacterium) abscessus complex, Mycolicibacterium (Mycobacterium) fortuitum, and Mycobacteroides (Mycobacterium) chelonae. J Infect Chemother 2018; 25:117-123. [PMID: 30447882 DOI: 10.1016/j.jiac.2018.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
Abstract
The drug susceptibility of rapidly growing mycobacteria (RGM) varies among isolates. Treatment strategies similarly differ depending on the isolate, and for some, no clear strategy has been identified. This complicates clinical management of RGM. Following Clinical and Laboratory Standards Institute standard M24-A2, we assessed the susceptibility of 140 RGM isolates to 14 different antimicrobial drugs by measuring their minimal inhibitory concentrations (MICs). We also investigated the correlation of clarithromycin (CAM) MICs with the erm(41) and rrl gene mutations in the Mycobacteroides (Mycobacterium) abscessus complex, the rrl mutation in Mycobacteroides (Mycobacterium) chelonae, and the erm(39) mutation in Mycolicibacterium (Mycobacterium) fortuitum to determine the contribution of these mutations to CAM susceptibility. The five species and subspecies examined included 48 M. abscessus subsp. abscessus isolates (34.3%), 35 (25.0%) being M. abscessus subsp. massiliense, and two (1.4%) being M. abscessus subsp. bolletii. The M. abscessus complex accounted for 85 isolates (60.7%) in total, whereas 43 isolates (30.7%) were M. fortuitum, and 12 (8.6%) were M. chelonae. Our results demonstrated species-specific susceptibility to antimicrobials. In most cases, susceptibility to CAM could be predicted based on genetic pattern, but since one isolate did not fit that pattern, MIC values needed to be measured. Some isolates also exhibited rates of resistance to other drugs that differed from those previously reported in other locations, indicating that accurate identification of the bacterial isolate and use of the correct method for determining MIC are both important for the diagnosis of RGM.
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Affiliation(s)
- Akio Aono
- Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Kiyose, Japan.
| | - Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Kinuyo Chikamatsu
- Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Kiyose, Japan
| | - Hiroyuki Yamada
- Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Kiyose, Japan
| | - Yuriko Igarashi
- Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Kiyose, Japan
| | - Yoshiro Murase
- Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Kiyose, Japan
| | - Akiko Takaki
- Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Kiyose, Japan
| | - Satoshi Mitarai
- Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Kiyose, Japan; Basic Mycobacteriosis, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Su TY, Ye JJ, Yang CC, Huang CT, Chia JH, Lee MH. Influence of borderline cefepime MIC on the outcome of cefepime-susceptible Pseudomonas aeruginosa bacteremia treated with a maximal cefepime dose: a hospital-based retrospective study. Ann Clin Microbiol Antimicrob 2017; 16:52. [PMID: 28738848 PMCID: PMC5525263 DOI: 10.1186/s12941-017-0227-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We assessed the influence of current cefepime minimal inhibitory concentration (MIC) breakpoints and the maximal cefepime dose on treatment outcomes in patients with bacteremia caused by cefepime-susceptible Pseudomonas aeruginosa. METHODS Adult patients hospitalized between July 2010 and June 2014 with a positive blood culture for cefepime-susceptible P. aeruginosa and receipt of cefepime as the primary therapy throughout the course were reviewed. Cefepime Etest® MICs and clinical outcomes for P. aeruginosa bacteremia were reviewed to identify the MIC breakpoint influencing treatment outcomes. RESULTS Of the 90 patients enrolled, 49 (54.4%) were male (mean age = 66.8 years). The mean Acute Physiology and Chronic Health Evaluation II score was 22.01. Sixty patients (66.7%) received a maximal cefepime dose, and the 30-day crude mortality rate was 36.7%. MIC90 of cefepime for P. aeruginosa was 8 mg/L. The cumulative survival rate at 30 days revealed that a lower cefepime MIC (<4 mg/L) for P. aeruginosa was associated with a higher survival rate than a higher MIC (≥4 mg/L) (72.6% vs. 23.5%, p < 0.0001). A cefepime MIC of ≥4 mg/L and age were independent risk factors for mortality, whereas the maximal cefepime dose was the independent protective factor. The use of a maximal cefepime dose did not improve the outcomes of patients with P. aeruginosa bacteremia at a MIC of ≥4 mg/L. CONCLUSIONS A cefepime MIC of 4 mg/L may predict an unfavorable outcome among patients with serious infections caused by P. aeruginosa, even the MICs still within the CLSI susceptibility breakpoint.
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Affiliation(s)
- Ting-Yi Su
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Shin Street, Gueishan 333, Taoyuan, Taiwan
| | - Jung-Jr Ye
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Shin Street, Gueishan 333, Taoyuan, Taiwan
| | - Chien-Chang Yang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Shin Street, Gueishan 333, Taoyuan, Taiwan
| | - Ching-Tai Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Shin Street, Gueishan 333, Taoyuan, Taiwan
| | - Ju-Hsin Chia
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Hsun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Shin Street, Gueishan 333, Taoyuan, Taiwan.
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