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 2 academic hospitals from 2005 to 2011. Outcomes of interest were (1) persistent bacteremia ≥1 calendar day and (2) 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 species bacteremia and received at least 1 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 ≥1 day after antibacterial initiation. None of the 36 patients who received single-agent cefepime (0%) had persistent bacteremia, as opposed to 4 of 16 (25%) of those who received single-agent carbapenem (P < .01). In multivariable models, there was no association between carbapenem use and persistent bacteremia (adjusted odds ratio [aOR], 1.52; 95% CI, .58-3.98; P = .39), and a nonsignificant lower odds ratio with cefepime use (aOR, 0.52; 95% CI, .19-1.40; P = .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.
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 2 academic hospitals from 2005 to 2011. Outcomes of interest were (1) persistent bacteremia ≥1 calendar day and (2) 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 species bacteremia and received at least 1 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 ≥1 day after antibacterial initiation. None of the 36 patients who received single-agent cefepime (0%) had persistent bacteremia, as opposed to 4 of 16 (25%) of those who received single-agent carbapenem (P < .01). In multivariable models, there was no association between carbapenem use and persistent bacteremia (adjusted odds ratio [aOR], 1.52; 95% CI, .58-3.98; P = .39), and a nonsignificant lower odds ratio with cefepime use (aOR, 0.52; 95% CI, .19-1.40; P = .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.
Authors: L Martínez-Martínez; M C Conejo; A Pascual; S Hernández-Allés; S Ballesta; E Ramírez De Arellano-Ramos; V J Benedí; E J Perea Journal: Antimicrob Agents Chemother Date: 2000-09 Impact factor: 5.191
Authors: Silke Polsfuss; Guido V Bloemberg; Jacqueline Giger; Vera Meyer; Erik C Böttger; Michael Hombach Journal: J Clin Microbiol Date: 2011-06-01 Impact factor: 5.948
Authors: C Feldman; S Alanee; V L Yu; G A Richards; A Ortqvist; J Rello; C C C Chiou; M B F Chedid; M M Wagener; K P Klugman Journal: Clin Microbiol Infect Date: 2009-09 Impact factor: 8.067
Authors: J W Chow; M J Fine; D M Shlaes; J P Quinn; D C Hooper; M P Johnson; R Ramphal; M M Wagener; D K Miyashiro; V L Yu Journal: Ann Intern Med Date: 1991-10-15 Impact factor: 25.391
Authors: David L Paterson; Wen-Chien Ko; Anne Von Gottberg; Sunita Mohapatra; Jose Maria Casellas; Herman Goossens; Lutfiye Mulazimoglu; Gordon Trenholme; Keith P Klugman; Robert A Bonomo; Louis B Rice; Marilyn M Wagener; Joseph G McCormack; Victor L Yu Journal: Ann Intern Med Date: 2004-01-06 Impact factor: 25.391
Authors: João Pires; Magdalena Taracila; Christopher R Bethel; Yohei Doi; Sara Kasraian; Regula Tinguely; Parham Sendi; Robert A Bonomo; Andrea Endimiani Journal: Antimicrob Agents Chemother Date: 2015-09-21 Impact factor: 5.191