Cefepime Therapy for Cefepime-Susceptible Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Bacteremia

Ruibin Wang; Sara E Cosgrove; Sarah Tschudin-Sutter; Jennifer H Han; Alison E Turnbull; Alice J Hsu; Edina Avdic; Karen C Carroll; Pranita D Tamma

doi:10.1093/ofid/ofw132

Cefepime Therapy for Cefepime-Susceptible Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Bacteremia

Open Forum Infect Dis. 2016 Jun 20;3(3):ofw132. doi: 10.1093/ofid/ofw132. eCollection 2016 Sep.

Authors

Ruibin Wang¹, Sara E Cosgrove², Sarah Tschudin-Sutter³, Jennifer H Han⁴, Alison E Turnbull⁵, Alice J Hsu⁶, Edina Avdic⁶, Karen C Carroll⁷, Pranita D Tamma⁸

Affiliations

¹ Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health.
² Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ Division of Infectious Diseases, University Hospital Basel, Switzerland.
⁴ Divisions of Infectious Diseases and Epidemiology, Hospital of the University of Pennsylvania, Philadelphia.
⁵ Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine.
⁶ Department of Pharmacy, The Johns Hopkins Hospital.
⁷ Division of Medical Microbiology, The Johns Hopkins University School of Medicine.
⁸ Department of Pediatrics, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

Abstract

The role of cefepime for extended-spectrum β-lactamase (ESBL) bacteremia is unclear if susceptible in vitro. In a propensity score-matched study of patients with ESBL bacteremia, risk of death was 2.87 times higher for patients receiving cefepime compared with carbapenems (95% confidence interval [CI], .88-9.41). We compared 14-day mortality of patients with ESBL bacteremia receiving empiric cefepime versus empiric carbapenem therapy in a propensity score-matched cohort. There was a trend towards increased mortality in the cefepime group (hazard ratio, 2.87; 95% CI, .88-9.41), which enhances the existing literature suggesting that cefepime may be suboptimal for invasive ESBL infections.

Keywords: ESBL; bacteremia; carbapenem; cefepime; multidrug-resistant organisms.