Marcelle D Alves1, Vanessa B Ribeiro2, Jardel P Tessari3, Francine Mattiello3, Giordanna De Bacco3, Daniela I Luz2, Fabiane J Vieira4, Tainá F Behle1, Alessandro C Pasqualotto5, Alexandre P Zavascki6. 1. Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St, Porto Alegre 90.035-903, Brazil. 2. Laboratório de Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. 3. School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 4. School of Biomedicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 5. School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil. 6. Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St, Porto Alegre 90.035-903, Brazil Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil azavascki@hcpa.ufrgs.br.
Abstract
OBJECTIVES: There are controversies regarding the association of cefepime therapy with increased mortality among patients with infections caused by Gram-negative bacteria (GNB). We evaluated the effect of cefepime on the mortality of patients with GNB bloodstream infections (BSIs). METHODS: A prospective cohort study was conducted in adult patients with creatinine ≤1.5 mg/dL who received empirical therapy with cefepime for at least 48 h for BSIs caused by GNB. The outcome was hospital mortality. Potential clinical predictors, including a high-dose regimen (2 g every 8 h), were assessed. RESULTS: One hundred and thirteen patients were included. Most (78.8%) isolates had low cefepime MICs (≤0.25 mg/L). The overall hospital mortality was 35.4% [25.6% (10/39) and 40.5% (30/74) in patients receiving high-dose and usual-dose cefepime, respectively (P = 0.17)]. In a Cox regression model adjusted for cefepime MIC and propensity score, a high-dose regimen was independently associated with lower mortality rates [adjusted hazard ratio (aHR) 0.41; 95% CI 0.18-0.91; P = 0.029] while presentation with severe sepsis or septic shock was independently associated with higher mortality rates (aHR 4.10; 95% CI 1.78-9.40; P = 0.001). A trend to lower mortality rates was also found in the subgroup analysis of patients who had not switched antibiotic during therapy after adjustment for the latter variables. CONCLUSIONS: High-dose cefepime therapy was associated with lower mortality rates in patients with GNB BSIs, even for GNB with low cefepime MICs.
OBJECTIVES: There are controversies regarding the association of cefepime therapy with increased mortality among patients with infections caused by Gram-negative bacteria (GNB). We evaluated the effect of cefepime on the mortality of patients with GNB bloodstream infections (BSIs). METHODS: A prospective cohort study was conducted in adult patients with creatinine ≤1.5 mg/dL who received empirical therapy with cefepime for at least 48 h for BSIs caused by GNB. The outcome was hospital mortality. Potential clinical predictors, including a high-dose regimen (2 g every 8 h), were assessed. RESULTS: One hundred and thirteen patients were included. Most (78.8%) isolates had low cefepime MICs (≤0.25 mg/L). The overall hospital mortality was 35.4% [25.6% (10/39) and 40.5% (30/74) in patients receiving high-dose and usual-dose cefepime, respectively (P = 0.17)]. In a Cox regression model adjusted for cefepime MIC and propensity score, a high-dose regimen was independently associated with lower mortality rates [adjusted hazard ratio (aHR) 0.41; 95% CI 0.18-0.91; P = 0.029] while presentation with severe sepsis or septic shock was independently associated with higher mortality rates (aHR 4.10; 95% CI 1.78-9.40; P = 0.001). A trend to lower mortality rates was also found in the subgroup analysis of patients who had not switched antibiotic during therapy after adjustment for the latter variables. CONCLUSIONS: High-dose cefepime therapy was associated with lower mortality rates in patients with GNB BSIs, even for GNB with low cefepime MICs.
Authors: Christina G Rivera; Prasanna P Narayanan; Robin Patel; Lynn L Estes Journal: Antimicrob Agents Chemother Date: 2016-05-23 Impact factor: 5.191
Authors: Nathaniel J Rhodes; Joseph L Kuti; David P Nicolau; Scott Van Wart; Anthony M Nicasio; Jiajun Liu; Benjamin J Lee; Michael N Neely; Marc H Scheetz Journal: Antimicrob Agents Chemother Date: 2015-12-14 Impact factor: 5.191
Authors: Kap Sum Foong; Abigail L Carlson; Satish Munigala; Carey-Ann D Burnham; David K Warren Journal: Open Forum Infect Dis Date: 2019-07-28 Impact factor: 3.835