RESUMO
Recently, extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli has been more frequently isolated from blood specimens than in the past. In this study we investigated a panel of therapeutic agents used to treat 37 patients with ESBL-producing E. coli bacteremia. Antimicrobial agents administered as definitive therapy displayed higher efficacy rates than when empiric therapy was administered (efficacy rates, 95.7% vs. 62.5%). The success rate of carbapenem was 95.8% (23/24) in patients with ESBL-producing E. coli bacteremia. In addition, the success rate of cefmetazole against ESBL-producing E. coli sensitive to this drug was 87.5% (7/8). In conclusion, patients at high risk of infection due to ESBL-producing E. coli should be empirically treated with carbapenem antibiotics. In addition, cefmetazole may be a treatment option for patients with ESBL-producing E. coli bacteremia.
Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Carbapenêmicos/uso terapêutico , Cefmetazol/uso terapêutico , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/enzimologia , beta-Lactamases/biossíntese , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Cefmetazol/farmacologia , Farmacorresistência Bacteriana , Escherichia coli/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Resultado do Tratamento , Adulto JovemRESUMO
The Guidelines for Management of Deep-seated Mycoses 2007 recommend the use of micafungin as a first-line agent for the treatment of candidemia. On the package insert, the recommended dose of micafungin is 50 mg/d. However, the Guidelines recommend a micafungin dose of 100-150 mg/d. In the present study, we evaluated the relationship between the effectiveness and dose of micafungin in 42 patients with candidemia who underwent treatment with micafungin. We found that the efficacy rate of micafungin at a dose of 50 mg/d was 40%, whereas that at ≥100 mg/d was 87.5%. Moreover, the treatment was more effective in patients who received ≥100 mg/d of micafungin as compared to those who received 50 mg/d of micafungin. Furthermore, we assessed the efficacy of micafungin according to the Candida species. Among all patients, the efficacy rate of micafungin was found to be lower in patients infected by Candida parapsilosis as compared to those infected by other Candida species. However, among the patients who received ≥100 mg/d of micafungin, the efficacy rate in patients infected by Candida parapsilosis was equivalent to that of patients who were infected by other Candida species. Thus, based on the results of the present study, the optimal micafungin dose for the treatment of candidemia appears to range from 100 to 150 mg/d, as recommended by the Guidelines.
