Cefmetazole for bacteremia caused by ESBL-producing enterobacteriaceae comparing with carbapenems.

Abstract

BACKGROUND:

ESBL (Extended spectrum beta-lactamase) producing enterobacteriaceae are challenging organisms with little treatment options. Carbapenems are frequently used, but the emergence of carbapenem resistant enterobacteriaceae is a concerning issue, which may hinder the use of carbapenems. Although cephamycins such as cefoxitin, cefmetazole or cefotetan are effective against ESBL-producers in vitro, there are few clinical data demonstrating effects against bacteremia caused by these organisms.

METHODS:

We performed a retrospective observational study on cases of bacteremia caused by ESBL-producers to investigate the efficacy of cefmetazole compared with carbapenems. We also evaluated whether the trend of antibiotic choice changed over years.

RESULTS:

Sixty-nine patients (male 34, age 69.2 ± 14.4), including two relapse cases, were reviewed for this analysis. The most common causative organisms were Escherichia coli (64, 93 %), followed by Klebsiella pneumoniae and K. oxytoca (2 each, 4 %). The group that received carbapenem therapy (43, 62 %) had increased severity in the Pittsburgh Bacteremic score than the group that received cefmetazole therapy, (1.5 ± 1.5 vs 2.5 ± 2.1, p = 0.048), while analysis of other factors didn't reveal any statistical differences. Five patients in the carbapenem group and one patient in the cefmetazole group died during the observation period (p = 0.24). CTX-M-9 were predominant in this series (59 %). Infectious disease physicians initially recommended carbapenems at the beginning of the current research period, which gradually changed over time favoring the use of cefmetazole instead (p = 0.002).

CONCLUSION:

Cefmetazole may be safely given to patients with bacteremia caused by ESBL-producers as a definitive therapy, if one can select out relatively stable patients.

• Authors: Takahiko Fukuchi, Kentaro Iwata, Saori Kobayashi, Tatsuya Nakamura, Goh Ohji
• Journal: BMC infectious diseases (BMC Infect Dis) Vol. 16 Issue 1 Pg. 427 (08 18 2016) ISSN: 1471-2334 [Electronic] England
• PMID: 27538488 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Carbapenems
• Cefmetazole
• beta-Lactamases

Topics

• Aged
• Anti-Bacterial Agents (therapeutic use)
• Bacteremia (drug therapy, microbiology)
• Carbapenems (therapeutic use)
• Cefmetazole (therapeutic use)
• Drug Resistance, Bacterial
• Enterobacteriaceae (enzymology)
• Escherichia coli (isolation & purification)
• Female
• Humans
• Klebsiella oxytoca (isolation & purification)
• Klebsiella pneumoniae (isolation & purification)
• Male
• Middle Aged
• Retrospective Studies
• Urinary Tract Infections (drug therapy, microbiology)
• beta-Lactamases (metabolism)