title: Clinical usefulness of the 2010 clinical and laboratory standards institute revised breakpoints for cephalosporin use in the treatment of bacteremia caused by Escherichia coli or Klebsiella spp.
abstract: We investigated the clinical usefulness of the revised 2010 Clinical and Laboratory Standards Institute (CLSI) breakpoints for Escherichia coli and Klebsiella spp. Of 2,623 patients with bacteremia caused by E. coli or Klebsiella spp., 573 who had been treated appropriately with cephalosporin based on the CLSI 2009 guidelines were enrolled. There were no differences in the rates of treatment failure or mortality between the appropriately and inappropriately treated groups according to the CLSI 2010 guidelines. Additionally, in the matched case-control analysis, the treatment failure rate was higher in bacteremic patients with extended-spectrum β-lactamase- (ESBL-) producing but cephalosporin-susceptible organisms than in those with ESBL-nonproducing isolates when patients with urinary tract infections were excluded (44% and 0%, resp., P = 0.026). In patients with bacteremia caused by E. coli or Klebsiella spp., the revised CLSI 2010 guidelines did not lead to poorer outcomes. However, ESBL production appeared to be associated with poor clinical outcomes in patients with bacteremia from sources other than the urinary tract.
authors: Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Nam Su
authors: NS
authors: Ku
authors: Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
authors: Hae-Sun
authors: HS
authors: Chung
authors: Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Jun Yong
authors: JY
authors: Choi
authors: Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Dongeun
authors: D
authors: Yong
authors: Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Kyungwon
authors: K
authors: Lee
authors: Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: June Myung
authors: JM
authors: Kim
authors: Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Yunsop
authors: Y
authors: Chong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D016022:Case-Control Studies; D002511:Cephalosporins / Q000627:therapeutic use*; D004926:Escherichia coli / Q000187:drug effects* / Q000378:metabolism; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000378:metabolism / Q000382:microbiology; D005260:Female; D006801:Humans; D007709:Klebsiella / Q000187:drug effects* / Q000378:metabolism; D007710:Klebsiella Infections / Q000188:drug therapy / Q000378:metabolism / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000378:metabolism / Q000382:microbiology; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D001618:beta-Lactamases