Cefepime versus other antibacterial agents for the treatment of Enterobacter species bacteremia.
Clin Infect Dis. 2014 Mar 18;
Authors: Siedner MJ, Galar A, Guzmán-Suarez BB, Kubiak DW, Baghdady N, Ferraro MJ, Hooper DC, O'Brien TF, Marty FM
Background. Carbapenems are recommended for treatment of Enterobacter infections with AmpC phenotypes. Although isolates are typically susceptible to cefepime in vitro, there are few data supporting its clinical efficacy. Methods. We reviewed all cases of Enterobacter species bacteremia at two academic hospitals from 2005-2011. Outcomes of interest were: a) persistent bacteremia ³ 1 calendar day and b) in-hospital mortality. We fit logistic regression models, adjusting for clinical risk factors and Pitt bacteremia score, and performed propensity score analyses to compare the efficacy of cefepime and carbapenems. Results. Three hundred sixty-eight patients experienced Enterobacter spp. bacteremia and received at least one antimicrobial agent, of whom 52 (14%) died during hospitalization. Median age was 59 years, 19% were neutropenic and 22% were in an intensive care unit on the day of bacteremia. Twenty-nine (11%) patients had persistent bacteremia for ³1 day after antibacterial initiation. None of the 36 patients who received single-agent cefepime (0%) had persistent bacteremia, as opposed to 4/16 (25%) of those who received single-agent carbapenem (P<0.01). In multivariable models, there was no association between carbapenem use and persistent bacteremia (adjusted odds ratio [aOR] 1.52, 95%CI 0.58Ð3.98, P=0.39), and a non-significant lower odds ratio with cefepime use (aOR 0.52, 95%CI 0.19Ð1.40, P=0.19). In-hospital mortality was similar for use of cefepime and carbapenems in adjusted regression models and propensity-score matched analyses. Conclusions. Cefepime has a similar efficacy as carbapenems for the treatment of Enterobacter species bacteremia. Its use should be further explored as a carbapenem-sparing agent in this clinical scenario.
PMID: 24647022 [PubMed - as supplied by publisher]