ArticleBMC infectious diseases2025
Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world study.
Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis 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).
methodsData 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.
results125 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.
conclusionsThe 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.
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