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Cefepime as effective as carbapenems for Enterobacter spp bacteremia
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The fourth-generation cephalosporin cefepime had similar efficacy as carbapenems in treating bacteremia caused by Enterobacter species, according to researchers from Brigham and Women’s Hospital and Massachusetts General Hospital.
“Our results support prior data that cefepime is effective for the treatment of Enterobacter spp. infections, based on the knowledge that these species often have a chromosomally encoded AmpC type beta-lactamase to which cefepime is relatively more stable than other cephalosporins,” the researchers wrote in Clinical Infectious Diseases. “We would suggest cefepime as an agent of choice for isolates with a [minimum inhibitory concentration] of 2 mcg/mL or more, since approximately 97% of patients with such isolates cleared bacteremia within one day of cefepime initiation.”
The researchers identified cases of Enterobacter spp. bacteremia receiving antibacterial treatment from January 2005 to March 2011 at Brigham and Women’s and Massachusetts General Hospitals. They collected data on antimicrobial agents used, days to bacteremia clearance and in-hospital mortality.
During the study period, 368 patients had Enterobacter spp. bacteremia and received at least one antimicrobial. Twenty-nine patients had persistent bacteria 1 or more days after starting antimicrobial treatment. Among the 36 patients who had received cefepime monotherapy, none had persistent bacteremia beyond 1 day. In comparison, four patients among the 16 who received single-agent carbapenem had persistent bacteremia.
There were 122 patients who received a single antimicrobial agent, and among these, the adjusted odds of persistent bacteremia was lowest with cefepime (OR=0) and highest for carbapenems (OR=8.8; 95% CI, 1-77.8). Among all patients receiving single or combination therapy, no antimicrobial was significantly associated with odds of bacteremia clearance within 1 day. Those who received cefepime had the lowest odds of persistent bacteremia (adjusted OR=0.5; 95% CI, 0.18-1.35) and those receiving carbapenems had the highest odds of persistent bacteremia (adjusted OR=1.51; 95% CI, 0.58-3.96).
The lowest rates of mortality were seen with ceftriaxone and quinolones, in which there was no incidence of mortality. Seven of 42 (17%) people receiving cefepime died compared with five of 19 people (26%) receiving carbapenems. The odds of mortality were similar for the two after multivariable analysis.
Disclosure: The researchers report no relevant financial disclosures.
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