Efficacy and Safety of Cefmetazole for Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Enterobacterales vs Carbapenems: A Retrospective Study.

Abstract

Background:

Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales have become a global concern owing to increased infections, high mortality, and limited antibiotic treatment options. Carbapenems (CPMs) are effective against ESBL-producing Enterobacterales, but their overuse leads to the emergence of multidrug-resistant bacteria. Cefmetazole (CMZ) is effective in vitro; however, its clinical efficacy remains unclear.

Methods:

We retrospectively reviewed patients who were treated with CMZ or CPMs for bacteremia caused by ESBL-producing Enterobacterales between 1 April 2014 and 31 September 2022 at Tenri Hospital. The primary outcome measure was 90-day mortality. We also evaluated resistance genes and sequence types of ESBL-producing Enterobacterales.

Results:

In total, 156 patients were enrolled in this study. Ninety patients (58%) received CMZ therapy. Patients in the CMZ group were significantly older than those in the CPM group (median [IQR], 79 years [71-86] vs 74 years [64-83]; P = .001). The severity of the Pitt bacteremia score of the CMZ group was lower than that in the CPM group (0 [0-2] vs 2 [0-2], P = .042). Six patients (7%) in the CMZ group and 10 (15%) in the CPM group died by day 90 (P = .110). Charlson Comorbidity Index and prevalence of sequence 131 between the groups were statistically insignificant.

Conclusions:

Our findings suggest that CMZ is a well-tolerated alternative to CPM for treating bacteremia caused by ESBL-producing Enterobacterales.

• Authors: Eriko Kashihara, Ryuichi Minoda Sada, Yukio Tsugihashi, Hitoshi Obayashi, Akihiro Nakamura, Noriyuki Abe, Hirofumi Miyake, Hiroyuki Akebo
• Journal: Open forum infectious diseases (Open Forum Infect Dis) Vol. 10 Issue 10 Pg. ofad502 (Oct 2023) ISSN: 2328-8957 [Print] United States
• PMID: 37901123 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.