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- W2912838383 abstract "Purpose: Carbapenems and cefmetazole have been shown to be effective against the hydrolyzing activity of ESBL in vitro. Because spectrum of cefmetazole is narrower than that of carbapenems, usage of cefmetazole is more recommended to avoid increase of multi-drug resistant strains. However, not many studies have compared effectiveness of carbapenems and cefmetazole clinically in vivo. Hence, we conducted a retrospective study with patients if cefmetazole is similarly effective like carbapenems against ESBL-producing bacteria. Methods & Materials: One hundred and twenty-eight patients who admitted our hospital from 2008 to 2016 enrolled this study. Fifty-three cases had urinary tract infections, 30, 19, 9, 17 cases had infections at respiratory tract, blood stream, bile duct, or other organs, respectively. Identified ESBL strains were E.coli (N = 93), Klebsiella spp (13), Proteus mirabilis (21), and polymicrobial infection (1). On their admission, all the patients had bacterial cultures, but ESBL-producing bacteria had not been identified yet at this point. By their physicians’ decision, all the patients received one antimicrobial empirically; carbapenem, cefmetazole, or other antimicrobials. All antimicrobials were administered intravenously for at least three days. After identification of ESBL, their medical records were checked retrospectively. If there are (1) improvement of clinical symptoms and/or (2) de-escalation or finished antimicrobial treatment, we concluded “clinically effective”. If the patient was dead or symptoms got worse, we concluded “not-effective”. Diagnosis of ESBL was performed using Siemens’ Microscan NegTM under the standard of Clinical and Laboratory Standards Institute. The institutional Review Board approved this research protocol. Results: Among 128 patients, 100 of them showed clinically effective, 28 were not. Carbapenem group showed clinically effective in 55 out of 62 cases, while cefmetazole group showed 27 out of 35 cases (p = 0.151). No significant differences in the 30-day mortality rates were observed between the groups. However, multiple logistic regression analysis revealed the use of carbapenems was significantly associated with the efficacy of treatment (odds ratio, 3.73; 95% confidence interval, 1.34–10.35; P = 0.012). Conclusion: Carbapenems were considered more effective than cefmetazole. However use of carbapenems should be limited properly because frequent usage induces resistant strains. More study is needed with consideration of antimicrobial dosage and bacterial genetic background." @default.
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- W2912838383 date "2019-02-01" @default.
- W2912838383 modified "2023-09-25" @default.
- W2912838383 title "Is cefmetazole effective like carbapenems to treat ESBL-producing bacterial infections in vivo?" @default.
- W2912838383 doi "https://doi.org/10.1016/j.ijid.2018.11.140" @default.
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