Meropenem: clinical response in relation to in vitro susceptibility

Drusano, George L.; Lode, H.; Edwards, Jeffrey R.

doi:10.1046/j.1469-0691.2000.00062.x

Cited by 21 publications

(14 citation statements)

References 45 publications

(55 reference statements)

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“…More treatment failures were also reported in a retrospective analysis of data from randomized trials on meropenem ( Fig. 2) (8). Only four patients with A. baumannii infections were included in that review.…”

Section: Resultsmentioning

confidence: 96%

“…(1,8,11,(16)(17)(18)(19). Several ␤-lactams were used, including cephalosporins, carbapenems, and ␤-lactams/␤-lactamase inhibitors.…”

Section: Resultsmentioning

confidence: 99%

“…Data for P. aeruginosa infections were provided by 4 articles (3,8,22,23). Yamagishi et al reported previously that the rate of microbiological failure was higher when the piperacillin-tazobactam value was 64 Ն MIC Ն 32 g/ml than when the MIC was Յ16 g/ml ( Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The electronic search provided 3,177 articles. Thirteen articles were included; data for 1,469 patients were ultimately eligible, from 2 articles on typhoid fever (5, 15), 7 on other enterobacteriaceae, (1,8,11,(16)(17)(18)(19), 5 on nonfermentative Gram-negative bacilli (1,3,8,22,23), and 2 on other Gram-negative bacteria (6,8). The characteristics of the included studies are presented in Table 1.…”

Section: Methodsmentioning

confidence: 99%

“…The characteristics of the included studies are presented in Table 1. One study provided data for enterobacteriaceae, Pseudomonas aeruginosa, and other Gram-negative bacteria (8), and another one provided data for Acinetobacter baumannii and enterobacteriaceae (1). ␤-Lactams were the antibiotics studied in all but three studies, in which fluoroquinolones and tigecycline were studied.…”

Section: Methodsmentioning

confidence: 99%

See 4 more Smart Citations

Impact of Antibiotic MIC on Infection Outcome in Patients with Susceptible Gram-Negative Bacteria: a Systematic Review and Meta-Analysis

Falagas

Tansarli

Rafailidis

et al. 2012

Antimicrob Agents Chemother

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The objective of this study was to analyze the impact of MIC values within the susceptible range of antibiotics on the outcomes of patients with Gram-negative infections. The PubMed and Scopus electronic databases were searched. We identified 13 articles (1,469 patients) that studied the impact of antibiotic MICs on the outcomes of infections; ␤-lactams were studied in 10 of them. A ntibiotic resistance has been an issue of debate since the introduction of antibiotics into clinical practice in the 1940s. At the beginning, it was demonstrated that antibiotics could inhibit bacterial growth in vitro in specific, minimal concentrations (MICs); since then, this value has been used to denote susceptibility in vivo and to guide clinical practice. However, it was not always possible to predict the clinical outcome of an infection based solely on the MIC. Moreover, the acquisition of resistant mechanisms either by mutations or through interbacterial communication has rendered bacteria more tolerant to antibiotics and more difficult to treat. As a result, susceptibility breakpoints kept changing over time (20). With time, several pharmacodynamic parameters have been associated more precisely with patient or infection outcomes for specific antibiotics.Despite these facts, susceptibility according to in vitro MICs continues to be a key factor in decision making. However, a recent meta-analysis reported that patients infected with vancomycinsusceptible Staphylococcus aureus isolates with vancomycin MICs of Ͼ1 g/ml had more treatment failures and higher mortality rates than patients infected with isolates with vancomycin MICs of Յ1 g/ml (data not shown). Moreover, the Clinical and Laboratory Standards Institute (CLSI) acknowledges that more treatment failures are expected for patients with typhoid fever treated with fluoroquinolones if the "susceptible" pathogen is resistant to nalidixic acid (4).Therefore, it is evident that the designations "sensitive," "intermediately sensitive," and even (to a lesser extent) "resistant" according to the MIC value do not fully reciprocate their meaning. In this context, we sought to review systematically the available evidence in order to examine whether high MIC values, within the susceptible range, are associated with worse outcomes than lower MIC values in infections caused by Gram-negative bacteria.

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Section: Resultsmentioning

confidence: 96%

“…(1,8,11,(16)(17)(18)(19). Several ␤-lactams were used, including cephalosporins, carbapenems, and ␤-lactams/␤-lactamase inhibitors.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Impact of Antibiotic MIC on Infection Outcome in Patients with Susceptible Gram-Negative Bacteria: a Systematic Review and Meta-Analysis

Falagas

Tansarli

Rafailidis

et al. 2012

Antimicrob Agents Chemother

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Impact of borderline minimum inhibitory concentration on the outcome of invasive infections caused by Enterobacteriaceae treated with β-lactams: a systematic review and meta-analysis

Torres

Delgado

Valiente

et al. 2015

Eur J Clin Microbiol Infect Dis

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Minimum inhibitory concentrations (MICs) have been used to denote susceptibility in vitro and to guide clinical practice. Our objective was to investigate whether the clinical outcomes of patients with invasive infections caused by Enterobacteriaceae treated with β-lactams were worse among those with a borderline susceptible MIC according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints than those with a lower MIC. Studies reporting MICs of β-lactams used for infection and clinical outcome were identified through a systematic literature search. Isolates were classified as "highly susceptible" (HS, those with MIC ≤1 dilution below the susceptibility breakpoint for the antibiotic used) and "borderline susceptible" (BS, isolates with MIC at the susceptibility breakpoint) using EUCAST criteria. Clinical outcomes were clinical cure and 30-day mortality. A meta-analysis was performed. Twenty-four studies were included. Taking all antimicrobials into consideration, the meta-analysis revealed no significant difference in mortality between HS and BS [odds ratio (OR) = 0.58; 95 % confidence interval (CI): 0.28-1.21; p = 0.148). However, HS was associated with higher cure rates than BS (OR = 3.73; 95 % CI: 1.76-7.92; p < 0.001). For specific antibiotics, no differences were found except for piperacillin-tazobactam, where higher clinical cure and lower mortality rates were seen with HS compared with BS isolates (OR = 3.17; 95 % CI: 1.09-9.20; p = 0.034 and OR = 0.12; 95 % CI: 0.02-0.92; p = 0.042; respectively). Our data suggest that HS isolates are associated with higher clinical cure rates than BS isolates according to EUCAST susceptibility breakpoints; this effect was evident only for piperacillin-tazobactam, probably because of limited numbers.

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Activity of meropenem and comparators against Pseudomonas aeruginosa and Acinetobacter spp. isolated in the MYSTIC Program, 2002–2004

Ünal

Garcı́a-Rodrı́guez

2005

Diagnostic Microbiology and Infectious Disease

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Meropenem: clinical response in relation to in vitro susceptibility

Cited by 21 publications

References 45 publications

Impact of Antibiotic MIC on Infection Outcome in Patients with Susceptible Gram-Negative Bacteria: a Systematic Review and Meta-Analysis

Impact of Antibiotic MIC on Infection Outcome in Patients with Susceptible Gram-Negative Bacteria: a Systematic Review and Meta-Analysis

Impact of borderline minimum inhibitory concentration on the outcome of invasive infections caused by Enterobacteriaceae treated with β-lactams: a systematic review and meta-analysis

Activity of meropenem and comparators against Pseudomonas aeruginosa and Acinetobacter spp. isolated in the MYSTIC Program, 2002–2004

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