ArticleOpen forum infectious diseases2023
High-dose Cefepime vs Carbapenems for Bacteremia Caused by Enterobacterales With Moderate to High Risk of Clinically Significant AmpC β-lactamase Production.
Article in Open forum infectious diseases, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- Cefepime and Mortality: A Systematic Review and Bayesian Meta-Analysis.JAMA network open · 2026Pooled it
- Pooled it
- Battle of the mnemonics, SPACE versus HECK-Yes! A cross-sectional, nationwide survey of infectious diseases clinicians to evaluate clinical and microbiologic practice patterns for infections caused by Enterobacterales at risk of inducible AmpC production.JAC-antimicrobial resistance · 2026Article
- Antimicrobial susceptibility and distribution trends among inducible AmpC-producing Enterobacterales at a regional health authority in British Columbia: a 5-year retrospective review.Access microbiology · 2026Article
- Comparison between cefepime and carbapenem therapy for deep-seated AmpC-producingAntimicrobial agents and chemotherapy · 2025Article
- Molecular and pharmacodynamic insights into β-lactam therapy for high-inoculumAntimicrobial agents and chemotherapy · 2025Article
- Cefepime Versus Carbapenem Therapy for the Treatment of Invasive Infections With Inducible Chromosomal AmpC-Producing Enterobacterales: A Systematic Review and Meta-analysis.Open forum infectious diseases · 2025Article
- Characteristics and Outcomes of Patients Treated with Carbapenem Versus Non-carbapenem Therapy for AmpC-Producing Enterobacterales Bacteremia: A Retrospective Study.Infectious diseases and therapy · 2025Article
- Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world study.BMC infectious diseases · 2025Article
- Article
- Antibiotic Treatment of Infections Caused by AmpC-Producing Enterobacterales.Pharmacy (Basel, Switzerland) · 2024Review
- Extended-Infusion β-Lactam Therapy, Mortality, and Subsequent Antibiotic Resistance Among Hospitalized Adults With Gram-Negative Bloodstream Infections.JAMA network open · 2024Article
- Mortality and Risk Factors of Death in Patients with AmpCInfection and drug resistance · 2024Article
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Limited data suggest that serious infections caused by Enterobacterales with a moderate to high risk of clinically significant AmpC production can be successfully treated with cefepime if the cefepime minimum inhibitory concentration (MIC) is ≤2 µg/mL. However, isolates with a cefepime-susceptible dose-dependent (SDD) MIC of 4-8 µg/mL should receive a carbapenem due to target attainment and extended-spectrum β-lactamase (ESBL) concerns. Methods: This was a retrospective cohort study of hospitalized patients with Results: Of the 315 patients included, 169 received cefepime and 146 received a carbapenem (ertapenem n = 90, meropenem n = 56). Cefepime was not associated with an increased risk of 30-day mortality compared with carbapenem therapy (adjusted hazard ratio [aHR], 1.45; 95% CI, 0.79-2.14), which was consistent for patients with cefepime SDD isolates (aHR, 1.19; 95% CI, 0.52-1.77). Multivariable weighted Cox models identified Pitt bacteremia score >4 (aHR, 1.41; 95% CI, 1.04-1.92), deep infection (aHR, 2.27; 95% CI, 1.21-4.32), and ceftriaxone-resistant AmpC-E (aHR, 1.32; 95% CI, 1.03-1.59) to be independent predictors associated with increased mortality risk, while receipt of prolonged-infusion β-lactam was protective (aHR, 0.67; 95% CI, 0.40-0.89). Conclusions: Among patients with bacteremia caused by Enterobacterales with moderate to high risk of clinically significant AmpC production, these data demonstrate similar risk of 30-day mortality for high-dose cefepime or a carbapenem as definitive β-lactam therapy.
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