Cheo Hao Min, Ho Darren Yan Kit, Koh Lin Pin, Koh Matthew Chung Yi, Ngiam Jinghao Nicholas, Lye David Chien Boon
Department of Infectious Diseases, National Centre for Infectious Diseases, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Open Forum Infect Dis. 2025 Jul 14;12(7):ofaf413. doi: 10.1093/ofid/ofaf413. eCollection 2025 Jul.
The optimal antibiotic choice for AmpC-producing Enterobacterales bloodstream infections (BSIs) and complicated urinary tract infections (cUTIs) remains to be clearly defined. Guidance from the Infectious Diseases Society of America recommends cefepime as first-line therapy, based on observational studies. We conducted a systematic review and meta-analysis to compare the clinical outcomes of cefepime versus carbapenems in patients with infections caused by AmpC-producing Enterobacterales.
A systematic search was conducted across Medline, Embase, Cochrane, and Scopus databases to identify studies comparing cefepime and carbapenems for the treatment of BSIs and cUTIs due to AmpC-producing Enterobacterales. Eligible studies reported all-cause mortality as the primary outcome. Secondary outcomes included clinical and microbiological cure, relapse, and adverse events. A random-effects meta-analysis was performed to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs).
Seven studies on BSI encompassing 1099 patients were included, with 479 receiving cefepime and 620 receiving carbapenem as definitive antibiotics. There were no studies on cUTI. No statistically significant difference in all-cause mortality was observed between cefepime and carbapenem treatment (log OR, 0.15 [95% CI, -.33 to .64]; = .54), although a nonsignificant trend favored cefepime, particularly in the subgroup of larger observational studies (n ≥ 50 patients) and more recent studies (published after 2019). Relapse rates were also comparable between the 2 groups (log OR, 0.39 [95% CI, -.25 to 1.03]; = .23).
In line with published guidance, treatment outcomes with cefepime did not differ significantly from carbapenems for AmpC-producing BSIs. However, randomized controlled trials are needed to validate these findings. PROSPERO: CRD42025634449.
对于产AmpC酶肠杆菌科细菌血流感染（BSIs）和复杂性尿路感染（cUTIs），最佳抗生素选择仍有待明确界定。美国传染病学会的指南基于观察性研究推荐头孢吡肟作为一线治疗药物。我们进行了一项系统评价和荟萃分析，以比较头孢吡肟与碳青霉烯类药物治疗产AmpC酶肠杆菌科细菌感染患者的临床结局。
在Medline、Embase、Cochrane和Scopus数据库中进行系统检索，以识别比较头孢吡肟和碳青霉烯类药物治疗产AmpC酶肠杆菌科细菌所致BSIs和cUTIs的研究。符合条件的研究将全因死亡率作为主要结局。次要结局包括临床和微生物学治愈、复发及不良事件。进行随机效应荟萃分析以估计合并比值比（ORs）及95%置信区间（CIs）。
纳入了7项关于BSI的研究，共1099例患者，其中479例接受头孢吡肟作为确定性抗生素治疗，620例接受碳青霉烯类药物治疗。没有关于cUTI的研究。头孢吡肟和碳青霉烯类药物治疗组之间在全因死亡率方面未观察到统计学显著差异（对数OR，0.15 [95% CI，-0.33至0.64]；P = 0.54），尽管有一个不显著的趋势支持头孢吡肟，特别是在较大规模观察性研究（n≥50例患者）和较新研究（2019年后发表）的亚组中。两组的复发率也相当（对数OR，0.39 [95% CI，-0.25至1.03]；P = 0.23）。
与已发表的指南一致，对于产AmpC酶的BSIs，头孢吡肟的治疗结局与碳青霉烯类药物相比无显著差异。然而，需要随机对照试验来验证这些发现。国际前瞻性系统评价注册库（PROSPERO）：CRD42025634449。
