Cefepime Therapy for Monomicrobial Bacteremia caused by Cefepime-susceptible Extended-Spectrum beta-Lactamase-Producing Enterobacteriaceae: MIC matters.
Clin Infect Dis. 2012 Oct 22;
Authors: Lee NY, Lee CC, Huang WH, Tsui KC, Hsueh PR, Ko WC
Background.?Extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae isolates are important clinical pathogens, and the efficacy of cefepime for such infections is controversial.Methods.?We performed a retrospective study of monomicrobial bacteremia due to ESBL producers at two medical centers between May 2002 and August 2007. The patients definitively treated by in vitro active cefepime (cases) were compared with those by a carbapenem (controls) in a propensity score-matched analysis to assess therapeutic effectiveness. The 30-day crude mortality is the primary end point.Results.?Overall 178 patients were eligible for the study. Patients with cefepime (n=17) as definitive therapy were more likely to have a clinical failure (odds ratio 6.2, 95% confidence interval [CI] 1.7-22.5, P=0.002), microbiological failure (OR 5.5, 95% CI 1.3-25.6, P=0.04), and 30-day mortality (OR 7.1, 95% CI 2.5-20.3, P<0.001) than those with carbapenem therapy (n=161). Multivariate regression revealed that a critical illness with a Pitt bacteremia score ?4 points (OR 5.4; 95% CI 1.4-20.9; P=0.016), a rapidly fatal underlying disease (OR 4.4; 95% CI 1.5-12.6; P=0.006), and definitive cefepime therapy (OR 9.9; 95% CI 2.8-31.9; P<0.001), were independently associated with 30-day crude mortality. In the propensity scores matched analysis, there were 17 case-control pairs, the survival analysis constantly found that individuals with cefepime therapy had a lower survival rate (log-rank test, P=0.016)Conclusions.?By the current CLSI susceptible breakpoint of cefepime (MIC ?8 ?g/mL), cefepime definitive therapy is inferior to carbapenem therapy in treating patients with so called "cefepime-susceptible" ESBL-producer bacteremia.
PMID: 23090931 [PubMed - as supplied by publisher]