ArticleCritical care (London, England)2023
Cefoxitin versus carbapenems as definitive treatment for extended-spectrum β-lactamase-producing Klebsiella pneumoniae bacteremia in intensive care unit: a propensity-matched retrospective analysis.
Article in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 7 citations in OpenAlex.
- Risk-Stratified Effectiveness of Cephamycins Versus Carbapenems for ESBL-ProducingAntibiotics (Basel, Switzerland) · 2026Review
- Prevalence of extended-spectrum β-lactamase and carbapenemase-producing Klebsiella pneumoniae in humans, animals and the environment in Northwest Amhara, Ethiopia.Scientific reports · 2026Article
- Unraveling the mechanisms behind the enhanced efficacy of β-lactam-based sideromycins.Communications biology · 2025Article
- Molecular Epidemiology and In-Depth Characterization ofInternational journal of molecular sciences · 2025Article
- Emergence and characterization of a novel ST627-KL8 carbapenem-resistantFrontiers in microbiology · 2025Article
- Mortality outcomes of extended-spectrum β-lactamase in bacteremia with carbapenems and other antibiotics: A systematic review.Journal of advanced pharmaceutical technology & researchReview
Corrections and comments
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Authors and funding
10 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDespite cefoxitin's in vitro resistance to hydrolysis by extended-spectrum beta-lactamases (ESBL), treatment of ESBL-producing Klebsiella pneumoniae (KP) infections with cefoxitin remains controversial. The aim of our study was to compare the clinical efficacy of cefoxitin as definitive antibiotic therapy for patients with ESBL-KP bacteremia in intensive care unit, versus carbapenem therapy.
methodsThis retrospective study included all patients with monomicrobial bacteremia hospitalized in intensive care unit between January 2013 and January 2023 at the University Hospital of Guadeloupe. The primary outcome was the 30-day clinical success defined as a composite endpoint: 30-day survival, absence of relapse and no change of antibiotic therapy. Cox regression including a propensity score (PS) and PS-based matched analysis were performed for endpoint analysis.
resultsA total of 110 patients with bloodstream infections were enrolled. Sixty-three patients (57%) received definitive antibiotic therapy with cefoxitin, while forty-seven (43%) were treated with carbapenems. 30-day clinical success was not significantly different between patients treated with cefoxitin (57%) and carbapenems (53%, p = 0.823). PS-adjusted and PS-matched analysis confirmed these findings. Change of definitive antibiotic therapy was more frequent in the cefoxitin group (17% vs. 0%, p = 0.002). No significant differences were observed for the other secondary endpoints. The acquisition of carbapenem-resistant Pseudomonas aeruginosa was significantly higher in patients receiving carbapenem therapy (5% vs. 23%, p = 0.007).
conclusionsOur results suggest that cefoxitin as definitive antibiotic therapy could be a therapeutic option for some ESBL-KP bacteremia, sparing carbapenems and reducing the selection of carbapenem-resistant Pseudomonas aeruginosa strains.
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