Volume 26 Issue 4 - April 11, 2014 PDF
Cefepime Therapy for Monomicrobial Bacteremia caused by Cefepime-susceptible Extended-Spectrum beta-Lactamase-Producing Enterobacteriaceae: MIC matters
Nan-Yao Lee1, Ching-Chi Lee1, Wei-Han Huang2, Ko-Chung Tsui3,4, Po-Ren Hsueh5, Wen-Chien Ko1,6,*
1 Department of Internal Medicine and Center for Infection Control, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan
2 Department of Clinical Pathology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
3 Department of Clinical Pathology Cathay General Hospital, Taipei, Taiwan
4 Fu-Jen Catholic University School of Medicine, New Taipei City, Taiwan
5 Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
6 Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan
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Extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae isolates are important clinical pathogens, and the efficacy of cefepime in such a clinical setting is controversial. A retrospective study of monomicrobial bacteremia due to ESBL producers at two medical centers between May 2002 and August 2007 were conducted. 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. Overall 178 patients were eligible for the study. We used the 30-day crude mortality as primary end point. Patients with cefepime (n=17) as definitive therapy were more likely to have a clinical failure, microbiological failure, and 30-day mortality than those with carbapenem therapy (n=161). Multivariate regression found a critical illness with a Pitt bacteremia score ≥4 points, a rapidly fatal underlying disease, and definitive cefepime therapy, were independently associated with mortality. In the propensity scores matched analysis of 17 case-control pairs, individuals with cefepime therapy had a lower survival rate. By the current CLSI susceptible breakpoint of cefepime (MIC ≤8 μg/mL), cefepime definitive therapy is inferior to carbapenem therapy in treating patients with bacteremia caused by “cefepime-susceptible” ESBL-producers.
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