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.

Table 4

Clinical manifestations of 10 patients with a cephalosporin as an appropriate definitive antimicrobial treatment under revised CLSI 2010 guidelines.

Number	Gender/age	Organisms	Site of acquisition	Underlying disease	Site of infection	Septic shock at the time of bacteremia	Definitive antimicrobials	CLSI; 2010	ESBL-producing	Treatment failure^a	28-day mortality
1	M/45	KOX	HA	AGC	Biliary	Yes	Ceftriaxone^b	Susceptible	Yes	Yes	Yes
2	F/46	KPN	HA	ESRD on HD	Primary	No	Ceftriaxone^b	Susceptible	Yes	No	No
3	M/56	ECO	CA	AGC	Biliary	Yes	Cefpiramide^c	Susceptible	Yes	No	No
4	M/63	ECO	CA	CBD stone, CKD, megaloblastic anemia	Biliary	No	Cefpiramide^c	Susceptible	Yes	Yes	No
5	M/64	ECO	HA	Mantle cell lymphoma	Primary	No	Ceftriaxone^b	Susceptible	Yes	No	No
6	M/64	KOX	HA	Rectal cancer	Urinary tract	No	Cefpiramide^c	Susceptible	Yes	No	No
7	M/67	ECO	HA	HCC (B-viral)	Biliary	Yes	Cefotaxime^d	Susceptible	Yes	Yes	No
8	F/72	ECO	CA	DM, CKD	Urinary tract	No	Ceftriaxone^b	Susceptible	Yes	No	No
9	M/81	ECO	CA	CBD stone	Biliary	Yes	Cefpiramide^c	Susceptible	Yes	No	No
10	F/84	ECO	CA	DM	Urinary tract	No	Ceftriaxone^b	Susceptible	Yes	No	No

CLSI, Clinical and Laboratory Standards Institute; ESBL, extended-spectrum -lactamase; ECO, Escherichia coli; KPN, Klebsiella pneumonia; KOX, Klebsiellaoxytoca; HA, hospital acquired; CA, community acquired; AGC, advanced gastric cancer; ESRD, end stage renal disease; HD, hemodialysis; CBD, common bile duct; HCC, hepatocellular carcinoma; DM, diabetes mellitus; CKD, chronic kidney disease.
72 hrs after administration of definitive antimicrobials.
2.0 g intravenous once a day.
1.0 g intravenous three times a day.
1.0 g intravenous three times a day.