Disease Control and Prevention Center, National Center for Global Health and Medicine , Tokyo, Japan.
Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine , Kyoto, Japan.
Antimicrob Agents Chemother. 2023 Oct 18;67(10):e0051023. doi: 10.1128/aac.00510-23. Epub 2023 Sep 13.
Cefmetazole is active against extended-spectrum β-lactamase-producing (ESBLEC) and is a potential candidate for carbapenem-sparing therapy. This multicenter, observational study included patients hospitalized for invasive urinary tract infection due to ESBLEC between March 2020 and November 2021 at 10 facilities in Japan, for whom either cefmetazole or meropenem was initiated as a definitive therapy within 96 h of culture collection and continued for at least 3 d. Outcomes included clinical and microbiological effectiveness, recurrence within 28 d, and all-cause mortality (14 d, 30 d, in-hospital). Outcomes were adjusted for the inverse probability of propensity scores for receiving cefmetazole or meropenem. Eighty-one and forty-six patients were included in the cefmetazole and meropenem groups, respectively. Bacteremia accounted for 43% of the cefmetazole group, and 59% of the meropenem group. The crude clinical effectiveness, 14 d, 30 d, and in-hospital mortality for patients in the cefmetazole and meropenem groups were 96.1% vs 90.9%, 0% vs 2.3%, 0% vs 12.5%, and 2.6% vs 13.3%, respectively. After propensity score adjustment, clinical effectiveness, the risk of in-hospital mortality, and the risk of recurrence were similar between the two groups ( = 0.54, = 0.10, and = 0.79, respectively). In all cases with available data (cefmetazole : = 61, meropenem : = 22), both drugs were microbiologically effective. In all isolates, was detected as the extended-spectrum β-lactamase gene. The predominant CTX-M subtype was CTX-M-27 (47.6%). Cefmetazole showed clinical and bacteriological effectiveness comparable to meropenem against invasive urinary tract infection due to ESBLECs.
头孢美唑对产超广谱β-内酰胺酶（ESBLEC）具有活性，是碳青霉烯类药物节约疗法的潜在候选药物。这项多中心、观察性研究纳入了 2020 年 3 月至 2021 年 11 月期间日本 10 家机构因 ESBLEC 导致侵袭性尿路感染住院的患者，这些患者在培养物采集后 96 小时内开始接受头孢美唑或美罗培南作为确定性治疗，且至少连续治疗 3 天。结局包括临床和微生物学疗效、28 天内复发以及全因死亡率（14 天、30 天、住院期间）。结局根据接受头孢美唑或美罗培南的倾向评分逆概率进行了调整。头孢美唑组和美罗培南组分别纳入了 81 例和 46 例患者。头孢美唑组中血培养阳性占 43%，美罗培南组中血培养阳性占 59%。头孢美唑组和美罗培南组患者的临床疗效、14 天、30 天和住院期间的死亡率分别为 96.1%比 90.9%、0%比 2.3%、0%比 12.5%和 2.6%比 13.3%。在倾向评分调整后，两组之间的临床疗效、住院期间死亡率风险和复发风险相似（ = 0.54， = 0.10， = 0.79）。在所有有可用数据的病例中（头孢美唑： = 61，美罗培南： = 22），两种药物均具有微生物学疗效。在所有分离株中，均检测到作为超广谱β-内酰胺酶基因的 。主要 CTX-M 亚型为 CTX-M-27（47.6%）。头孢美唑对产 ESBLEC 的侵袭性尿路感染的临床和细菌学疗效与美罗培南相当。
