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Effect of elevated imipenem/cilastatin minimum inhibitory concentrations on patient outcomes in Gram-negative

Milena M McLaughlin1, Cristina Miglis1, Erik Skoglund2

  • 1Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, USA; Northwestern Memorial Hospital, Chicago, IL, USA.

Journal of Global Antimicrobial Resistance
|February 13, 2018
PubMed
Abstract

Insights

This study found no direct link between carbapenem use and mortality in patients with carbapenem-resistant Gram-negative bloodstream infections. Directed therapy, however, was associated with reduced mortality.

Area of Science:

  • Clinical Microbiology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Carbapenem minimum inhibitory concentrations (MICs) predict outcomes in Gram-negative bacteraemia.
  • Limited data exist on MICs' impact in carbapenem-resistant infections.
  • Understanding these relationships is crucial for guiding treatment strategies.

Purpose of the Study:

  • To evaluate the effect of increasing imipenem/cilastatin MICs on mortality in Gram-negative bloodstream infections (BSI).
  • To investigate the influence of carbapenem therapy on outcomes in resistant BSI cases.

Main Methods:

  • Retrospective study of 62 patients with imipenem/cilastatin-resistant Gram-negative BSI (MIC > 4 mg/L).
  • Assessment of baseline characteristics, organ function, microbiological data, and treatment.
  • Time to event analyses were performed to compare outcomes.

Main Results:

  • No significant difference in mortality between patients receiving carbapenem therapy and those who did not (P=0.10).
  • Directed therapy was associated with significantly lower mortality (adjusted hazard ratio=0.35, P<0.01).
  • Higher APACHE II scores and delayed positive cultures predicted non-survival.

Conclusions:

  • This study did not demonstrate a direct relationship between carbapenem receipt and mortality in carbapenem-resistant Gram-negative BSI.
  • Directed antimicrobial therapy appears to be a key factor in improving survival for these infections.
Keywords:
Bloodstream infectionCarbapenemGram-negativeMICMinimum inhibitory concentrationMortality

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