%0 Journal Article %1 Lee2013 %A Lee, Nan-Yao %A Lee, Ching-Chi %A Huang, Wei-Han %A Tsui, Ko-Chung %A Hsueh, Po-Ren %A Ko, Wen-Chien %D 2013 %J Clin Infect Dis %K drug drugresistance betalactamases dosing %N 4 %P 488--495 %R 10.1093/cid/cis916 %T Cefepime Therapy for Monomicrobial Bacteremia Caused by Cefepime-Susceptible Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae: MIC Matters. %U http://dx.doi.org/10.1093/cid/cis916 %V 56 %X Background. Extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae isolates are important clinical pathogens. In addition, the efficacy of cefepime for such infections is controversial. Methods. We performed a retrospective study of monomicrobial bacteremia caused by ESBL producers at 2 medical centers between May 2002 and August 2007. The patients definitively treated with in vitro active cefepime (cases) were compared with those treated with a carbapenem (controls) in a propensity score-matched analysis to assess therapeutic effectiveness. The 30-day crude mortality is the primary endpoint. Results. A total of 178 patients were eligible for the study. Patients who received cefepime (n = 17) as definitive therapy were more likely to have a clinical failure (odds ratio OR 6.2; 95\% confidence interval CI, 1.7-22.5; P = .002), microbiological failure (OR 5.5; 95\% CI, 1.3-25.6; P = .04), and 30-day mortality (OR 7.1; 95\% CI, 2.5-20.3; P < .001) than those who received carbapenem therapy (n = 161). Multivariate regression revealed that a critical illness with a Pitt bacteremia score ≥4 points (OR 5.4; 95\% CI, 1.4-20.9; P = .016), a rapidly fatal underlying disease (OR 4.4; 95\% CI, 1.5-12.6; P = .006), and definitive cefepime therapy (OR 9.9; 95\% CI, 2.8-31.9; P < .001) were independently associated with 30-day crude mortality. There were 17 case-control pairs in the propensity scores matched analysis. The survival analysis consistently found that individuals who received cefepime therapy had a lower survival rate (log-rank test, P = .016). Conclusions. Based on the current Clinical and Laboratory Standards Institute susceptible breakpoint of cefepime (minimum inhibitory concentration ≤8 μg/mL), cefepime definitive therapy is inferior to carbapenem therapy in treating patients with so-called cefepime-susceptible ESBL-producer bacteremia.

@article{Lee2013, abstract = {Background. Extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae isolates are important clinical pathogens. In addition, the efficacy of cefepime for such infections is controversial. Methods. We performed a retrospective study of monomicrobial bacteremia caused by ESBL producers at 2 medical centers between May 2002 and August 2007. The patients definitively treated with in vitro active cefepime (cases) were compared with those treated with a carbapenem (controls) in a propensity score-matched analysis to assess therapeutic effectiveness. The 30-day crude mortality is the primary endpoint. Results. A total of 178 patients were eligible for the study. Patients who received cefepime (n = 17) as definitive therapy were more likely to have a clinical failure (odds ratio [OR] 6.2; 95\% confidence interval [CI], 1.7-22.5; P = .002), microbiological failure (OR 5.5; 95\% CI, 1.3-25.6; P = .04), and 30-day mortality (OR 7.1; 95\% CI, 2.5-20.3; P < .001) than those who received carbapenem therapy (n = 161). Multivariate regression revealed that a critical illness with a Pitt bacteremia score ≥4 points (OR 5.4; 95\% CI, 1.4-20.9; P = .016), a rapidly fatal underlying disease (OR 4.4; 95\% CI, 1.5-12.6; P = .006), and definitive cefepime therapy (OR 9.9; 95\% CI, 2.8-31.9; P < .001) were independently associated with 30-day crude mortality. There were 17 case-control pairs in the propensity scores matched analysis. The survival analysis consistently found that individuals who received cefepime therapy had a lower survival rate (log-rank test, P = .016). Conclusions. Based on the current Clinical and Laboratory Standards Institute susceptible breakpoint of cefepime (minimum inhibitory concentration ≤8 μg/mL), cefepime definitive therapy is inferior to carbapenem therapy in treating patients with so-called cefepime-susceptible ESBL-producer bacteremia.}, added-at = {2013-02-28T03:12:48.000+0100}, author = {Lee, Nan-Yao and Lee, Ching-Chi and Huang, Wei-Han and Tsui, Ko-Chung and Hsueh, Po-Ren and Ko, Wen-Chien}, biburl = {https://www.bibsonomy.org/bibtex/2cbcd3409429ff754ee803c2229f4ca2d/aorchid}, description = {Disappointing findings. Unless MIC<2 cefepime as monotherapy was not effective. State that dosing was 1-2g q8h. This was not included in analysis. If 1g q8h then would expect to fail with MIC >4.}, doi = {10.1093/cid/cis916}, file = {:ID_General/ClinInfectDis.56.488.pdf:PDF}, groups = {public}, institution = {Department of Internal Medicine.}, interhash = {51fb6439b161d707ded2e77d0b88f2ee}, intrahash = {cbcd3409429ff754ee803c2229f4ca2d}, journal = {Clin Infect Dis}, keywords = {drug drugresistance betalactamases dosing}, language = {eng}, medline-pst = {ppublish}, month = Feb, number = 4, pages = {488--495}, pii = {cis916}, pmid = {23090931}, timestamp = {2013-02-28T03:12:48.000+0100}, title = {Cefepime Therapy for Monomicrobial Bacteremia Caused by Cefepime-Susceptible Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae: MIC Matters.}, url = {http://dx.doi.org/10.1093/cid/cis916}, username = {aorchid}, volume = 56, year = 2013 }