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Background <p>This investigation aimed to compare the efficacy of cefepime and carbapenem for complicated urinary tract infection (cUTI) caused by presumptive AmpC β-lactamase-producing <i>Enterobacter spp.</i>,<i> Serratia marcescens</i>,<i> Citrobacter freundii</i>,<i> Providencia spp.</i>, and <i>Morganella morganii</i> (ESCPM).</p> Methods <p>Data of 458 individuals with cUTI caused by cefoxitin-nonsusceptible [minimum inhibitory concentration (MIC) &gt; 8&#xa0;µg/mL] and cefepime-susceptible (MIC ≤ 2&#xa0;µg/mL) ESCPM was acquired from four Chinese hospitals between 2010 and 2022 and were reviewed retrospectively.</p> Results <p>125 and 333 patients received cefepime and carbapenems, respectively, as antimicrobial therapy. The 28-day treatment failure rate was 15.7% (72/458). The following factors were identified as independent predictors for 28-day therapy: age, cefepime MIC = 2&#xa0;µg/mL, immunocompromised status, infection source control, appropriate empirical therapy, and days from illness onset to active therapy. In patients who required cefepime MIC ≤ 1&#xa0;µg/mL, a multivariate logistic model indicated that cefepime was linked with a similar risk of 28-day treatment failure [<i>odd ratio</i> (<i>OR</i>) 1.791, <i>95% confidence interval</i> (<i>CI</i>) 0.600–5.350, <i>p</i> = 0.296] compared with carbapenems after controlling these predictors. Compared with individuals with cefoxitin-nonsusceptible ESCPM, those with isolates of cefepime (MIC = 2&#xa0;µg/mL) had an enhanced risk of 28-day treatment failure (<i>OR</i> = 2.579, <i>95% CI</i> = 1.012–6.572, <i>p</i> = 0.047). A propensity score for treatment analysis validated this relationship.</p> Conclusions <p>The cefepime and carbapenem had comparable efficacy for treating cUTI caused by cefoxitin-nonsusceptible ESCPM organisms with cefepime MIC ≤ 1&#xa0;µg/mL, whereas carbapenems are potentially more effective for isolates with cefepime MIC = 2&#xa0;µg/mL.</p>

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Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月31日

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  • Liang Chen,
  • Jie Hua,
  • Xiaopu He

摘要

Background

This investigation aimed to compare the efficacy of cefepime and carbapenem for complicated urinary tract infection (cUTI) caused by presumptive AmpC β-lactamase-producing Enterobacter spp., Serratia marcescens, Citrobacter freundii, Providencia spp., and Morganella morganii (ESCPM).

Methods

Data of 458 individuals with cUTI caused by cefoxitin-nonsusceptible [minimum inhibitory concentration (MIC) > 8 µg/mL] and cefepime-susceptible (MIC ≤ 2 µg/mL) ESCPM was acquired from four Chinese hospitals between 2010 and 2022 and were reviewed retrospectively.

Results

125 and 333 patients received cefepime and carbapenems, respectively, as antimicrobial therapy. The 28-day treatment failure rate was 15.7% (72/458). The following factors were identified as independent predictors for 28-day therapy: age, cefepime MIC = 2 µg/mL, immunocompromised status, infection source control, appropriate empirical therapy, and days from illness onset to active therapy. In patients who required cefepime MIC ≤ 1 µg/mL, a multivariate logistic model indicated that cefepime was linked with a similar risk of 28-day treatment failure [odd ratio (OR) 1.791, 95% confidence interval (CI) 0.600–5.350, p = 0.296] compared with carbapenems after controlling these predictors. Compared with individuals with cefoxitin-nonsusceptible ESCPM, those with isolates of cefepime (MIC = 2 µg/mL) had an enhanced risk of 28-day treatment failure (OR = 2.579, 95% CI = 1.012–6.572, p = 0.047). A propensity score for treatment analysis validated this relationship.

Conclusions

The cefepime and carbapenem had comparable efficacy for treating cUTI caused by cefoxitin-nonsusceptible ESCPM organisms with cefepime MIC ≤ 1 µg/mL, whereas carbapenems are potentially more effective for isolates with cefepime MIC = 2 µg/mL.