Department of Pharmacy, Christus Spohn Health System, Corpus Christi, TX, USA.
Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Int J Antimicrob Agents. 2023 May;61(5):106762. doi: 10.1016/j.ijantimicag.2023.106762. Epub 2023 Feb 18.
Cefepime is a first-line agent for empiric sepsis therapy; however, cefepime use may be associated with increased mortality for extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) in an MIC-dependent manner. This study aimed to compare the efficacy of empiric cefepime versus meropenem for bloodstream infections (BSI) caused by ceftriaxone-resistant Escherichia coli and Klebsiella pneumoniae with cefepime MICs ≤ 2 mg/L.
This single-center retrospective cohort study included patients admitted from October 2010 to August 2020 who received cefepime or meropenem empirically for sepsis with a blood culture growing ceftriaxone-resistant Escherichia coli or Klebsiella pneumoniae. The primary outcome was 30-day mortality; secondary endpoints included 14-day mortality, recurrent BSI, readmission and recurrent infection within 90 days, time to clinical resolution of infection, time to clinical stability, and clinical stability at 48 hours.
Fifty-four patients met inclusion criteria: 36 received meropenem and 18 received cefepime. The median (IQR) treatment durations of cefepime and meropenem were 3 (2-6) days and 7 (5-10) days, respectively. Thirty-day and 14-day mortality were similar between cefepime and meropenem (11.1% vs. 2.8%; P = 0.255 and 5.6% vs. 2.8%; P = 1.00, respectively). Cefepime was associated with longer time to clinical stability compared with meropenem (median 38.48 hours vs. 21.26; P = 0.016).
Mortality was similar between groups, although most patients who received cefepime empirically were ultimately transitioned to a carbapenem to complete the full treatment course. Empiric cefepime was associated with a delay in achieving clinical stability when compared with meropenem to treat BSI caused by ceftriaxone-resistant Enterobacterales, even when cefepime-susceptible.
头孢吡肟是经验性脓毒症治疗的一线药物；然而，头孢吡肟的使用可能与 MIC 依赖性方式下产超广谱β-内酰胺酶肠杆菌科（ESBL-E）的死亡率增加有关。本研究旨在比较经验性头孢吡肟与美罗培南治疗头孢曲松耐药的大肠埃希菌和肺炎克雷伯菌血流感染（BSI）的疗效，这些患者的头孢吡肟 MICs ≤ 2mg/L。
这是一项单中心回顾性队列研究，纳入了 2010 年 10 月至 2020 年 8 月期间因脓毒症接受经验性头孢吡肟或美罗培南治疗且血培养出头孢曲松耐药大肠埃希菌或肺炎克雷伯菌的患者。主要结局为 30 天死亡率；次要结局包括 14 天死亡率、复发性 BSI、90 天内再入院和再感染、感染临床缓解时间、临床稳定时间和 48 小时临床稳定。
54 名患者符合纳入标准：36 名接受美罗培南治疗，18 名接受头孢吡肟治疗。头孢吡肟和美罗培南的中位（IQR）治疗持续时间分别为 3（2-6）天和 7（5-10）天。头孢吡肟和美罗培南的 30 天和 14 天死亡率相似（11.1% vs. 2.8%；P=0.255 和 5.6% vs. 2.8%；P=1.00）。与美罗培南相比，头孢吡肟达到临床稳定的时间更长（中位数 38.48 小时 vs. 21.26；P=0.016）。
两组死亡率相似，尽管大多数接受经验性头孢吡肟治疗的患者最终转为碳青霉烯类药物以完成完整的治疗疗程。与美罗培南相比，经验性头孢吡肟治疗头孢曲松耐药肠杆菌科引起的 BSI 时，即使头孢吡肟敏感，也会导致临床稳定时间延迟。
