{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T03:29:02Z","timestamp":1772162942218,"version":"3.50.1"},"reference-count":36,"publisher":"American Society for Microbiology","issue":"9","license":[{"start":{"date-parts":[[2012,9,1]],"date-time":"2012-09-01T00:00:00Z","timestamp":1346457600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2012,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Predictive modeling suggests that actual carbapenem MIC results are more predictive of clinical patient outcomes than categorical classification of the MIC as susceptible, intermediate, or resistant. Some have speculated that current CLSI guidelines' suggested thresholds are too high and that clinical success is more likely if the MIC value is \u22641 mg\/liter for certain organisms. Patients treated with carbapenems and with positive blood cultures for\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Pseudomonas aeruginosa<\/jats:named-content>\n                    ,\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Acinetobacter baumannii<\/jats:named-content>\n                    , or extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria were considered for evaluation in this clinical retrospective cohort study. Relevant patient demographics and microbiologic variables were collected, including carbapenem MIC. The primary objective was to define a risk-adjusted all-cause hospital mortality breakpoint for carbapenem MICs. Secondarily, we sought to determine if a similar breakpoint existed for indirect outcomes (e.g., time to mortality and length of stay [LOS] postinfection for survivors). Seventy-one patients met the criteria for study inclusion. Overall, 52 patients survived, and 19 died. Classification and regression tree (CART) analysis determined a split of organism MIC between 2 and 4 mg\/liter and predicted differences in mortality (16.1% versus 76.9%;\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.01). Logistic regression controlling for confounders identified each imipenem MIC doubling dilution as increasing the probability of death 2-fold (adjusted odds ratio [aOR] 2.0; 95% confidence interval [CI], 1.3 to 3.2). Secondary outcomes were similar between groups. This study revealed that patients with organisms that had a MIC of \u22654 mg\/liter had worse outcomes than patients whose isolates had a MIC of \u22642 mg\/liter, even after adjustment for confounding variables. We recommend additional clinical studies to better understand the susceptibility breakpoint for carbapenems.\n                  <\/jats:p>","DOI":"10.1128\/aac.06365-11","type":"journal-article","created":{"date-parts":[[2012,7,10]],"date-time":"2012-07-10T11:23:25Z","timestamp":1341919405000},"page":"4885-4890","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":70,"title":["Evaluation of Clinical Outcomes in Patients with Bloodstream Infections Due to Gram-Negative Bacteria According to Carbapenem MIC Stratification"],"prefix":"10.1128","volume":"56","author":[{"given":"John S.","family":"Esterly","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA"},{"name":"Department of Pharmacy Practice, Chicago State University, Chicago, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie","family":"Wagner","sequence":"additional","affiliation":[{"name":"Midwestern University, Chicago College of Pharmacy, Downers Grove, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milena M.","family":"McLaughlin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA"},{"name":"Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Postelnick","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Pathology, Clinical Microbiology Division, Northwestern Memorial Hospital, Chicago, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc H.","family":"Scheetz","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA"},{"name":"Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","volume-title":"Abstr. 44th Intersci. 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