ArticleJournal of clinical microbiology2015
Clinical outcomes of Enterobacteriaceae infections stratified by carbapenem MICs.
Article in Journal of clinical microbiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 51 citations in OpenAlex.
- Empiric therapy for hospital-acquired, Gram-negative complicated intra-abdominal infection and complicated urinary tract infections: a systematic literature review of current and emerging treatment options.BMC infectious diseases · 2015Pooled it
- Epidemiology and carbapenemase gene distribution among carbapenem-resistant enterobacterales: a two-year retrospective study in a Saudi tertiary hospital.BMC microbiology · 2026Article
- Clinical outcomes and the impact of treatment modalities in children with carbapenem-resistant Enterobacteriaceae bloodstream infections: a retrospective cohort study from a tertiary university hospital.The Journal of antimicrobial chemotherapy · 2025Article
- In Vitro Dynamic Model Evaluation of Meropenem Alone and in Combination with Avibactam Against Carbapenemase-ProducingPharmaceuticals (Basel, Switzerland) · 2024Article
- Microbiological Characteristics, Risk Factors, and Short-Term Mortality of Carbapenem-ResistantInfection and drug resistance · 2024Article
- Production of OXA-48 carbapenemase acts as an independent risk factor for poor outcome in Klebsiella pneumoniae infection.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2023Article
- Updating breakpoints in the United States: a summary from the ASM Clinical Microbiology Open 2022.Journal of clinical microbiology · 2023Review
- Clinical, microbiological characteristics and predictors of mortality in patients with carbapenemase-producing Enterobacterales bloodstream infections: a multicentre study.Infection prevention in practice · 2023Article
- A Multicenter Comparison of Carbapenem-Nonsusceptible Enterobacterales and Pseudomonas aeruginosa Rates in the US (2016 to 2020): Facility-Reported Rates versus Rates Based on Updated Clinical Laboratory and Standards Institute Breakpoints.Microbiology spectrum · 2022Article
- Raising the Bar: Improving Antimicrobial Resistance Detection by Clinical Laboratories by Ensuring Use of Current Breakpoints.Open forum infectious diseases · 2022Article
- Imipenem Resistance in Gram-Negative Bacteria in the Central Pediatric Teaching Hospital in Baghdad, Iraq.Archives of Razi Institute · 2022Article
- Mortality Risk Factors and Prognostic Analysis of Patients with Multi-Drug ResistantInfection and drug resistance · 2022Article
- The Practical Problem With Carbapenem Testing and Reporting Accurate Bacterial Susceptibilities.Frontiers in pharmacology · 2022Review
- Population Pharmacokinetics of Meropenem in Critically Ill Korean Patients and Effects of Extracorporeal Membrane Oxygenation.Pharmaceutics · 2021Article
- Breakpoint beware: reliance on historical breakpoints for Enterobacteriaceae leads to discrepancies in interpretation of susceptibility testing for carbapenems and cephalosporins and gaps in detection of carbapenem-resistant organisms.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2020Article
- The Effect of Host Immunity on Predicting the Mortality of Carbapenem-Resistant Organism Infection.Frontiers in cellular and infection microbiology · 2020Article
- Antibiotic Breakpoints: How Redefining Susceptibility Preserves Efficacy and Improves Patient Care.P & T : a peer-reviewed journal for formulary management · 2019Article
- Understanding and Addressing CLSI Breakpoint Revisions: a Primer for Clinical Laboratories.Journal of clinical microbiology · 2019Review
- Public Health Efforts Can Impact Adoption of Current Susceptibility Breakpoints, but Closer Attention from Regulatory Bodies Is Needed.Journal of clinical microbiology · 2019Article
- Article
Corrections and comments
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Authors and funding
2 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The Clinical and Laboratory Standards Institute (CLSI) lowered the MIC breakpoints for meropenem and imipenem from 4 mg/liter to 1 mg/liter for Enterobacteriaceae in 2010. The breakpoint change improves the probability of pharmacodynamic target attainment and eliminates the need for microbiology labs to perform confirmatory testing for Klebsiella pneumoniae carbapenemase (KPC) production or other beta-lactamases that hydrolyze carbapenems. However, there are limited data evaluating clinical outcomes of the affected breakpoints, and it is unknown if patients infected with Enterobacteriaceae with reduced susceptibility are more likely to have poor outcomes when treated with a carbapenem. We conducted a single-center retrospective matched-cohort analysis in adult patients with Enterobacteriaceae infections treated with meropenem, imipenem, or doripenem. Patients with Enterobacteriaceae infection with a carbapenem MIC of 2 to 8 mg/liter were matched based on pathogen, source of infection, comorbidities, and disease severity (1:1 ratio) to those with a carbapenem MIC of ≤1 mg/liter. A total of 36 patients were included in the study. The group with carbapenem MICs of 2 to 8 mg/liter had a significantly higher 30-day mortality than the group with carbapenem MICs of ≤1 mg/liter (38.9% compared to 5.6%, P = 0.04). Total hospital length of stay (LOS) and intensive care unit (ICU) LOS were longer in the group with MICs of 2 to 8 mg/liter than in the group with MICs of ≤1 mg/liter (57.6 days compared to 34.4 days [P = 0.06] and 56.6 days compared to 21.7 days [P < 0.01], respectively). Patients infected with Enterobacteriaceae with a carbapenem MIC of 2, 4, or 8 mg/liter had higher mortality rates and longer ICU LOS than matched cohorts with carbapenem MICs of ≤1 mg/liter, which supports CLSI's recommendation to lower susceptibility breakpoints for carbapenems.
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