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Cefmetazole for bacteremia caused by ESBL-producing enterobacteriaceae comparing with carbapenems.
BMC Infect Dis. 2016 08 18; 16(1):427.BI

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+Show Affiliations

Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan. chicco@f.email.ne.jp. Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan. chicco@f.email.ne.jp.Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan. Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan.Department of Clinical Laboratory, Kobe University Hospital, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan.Department of Clinical Laboratory, Kobe University Hospital, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan.Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan. Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan. Department of Clinical Laboratory, Kobe University Hospital, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27538488

Citation

Fukuchi, Takahiko, et al. "Cefmetazole for Bacteremia Caused By ESBL-producing Enterobacteriaceae Comparing With Carbapenems." BMC Infectious Diseases, vol. 16, no. 1, 2016, p. 427.
Fukuchi T, Iwata K, Kobayashi S, et al. Cefmetazole for bacteremia caused by ESBL-producing enterobacteriaceae comparing with carbapenems. BMC Infect Dis. 2016;16(1):427.
Fukuchi, T., Iwata, K., Kobayashi, S., Nakamura, T., & Ohji, G. (2016). Cefmetazole for bacteremia caused by ESBL-producing enterobacteriaceae comparing with carbapenems. BMC Infectious Diseases, 16(1), 427. https://doi.org/10.1186/s12879-016-1770-1
Fukuchi T, et al. Cefmetazole for Bacteremia Caused By ESBL-producing Enterobacteriaceae Comparing With Carbapenems. BMC Infect Dis. 2016 08 18;16(1):427. PubMed PMID: 27538488.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cefmetazole for bacteremia caused by ESBL-producing enterobacteriaceae comparing with carbapenems. AU - Fukuchi,Takahiko, AU - Iwata,Kentaro, AU - Kobayashi,Saori, AU - Nakamura,Tatsuya, AU - Ohji,Goh, Y1 - 2016/08/18/ PY - 2015/11/13/received PY - 2016/08/10/accepted PY - 2016/8/20/entrez PY - 2016/8/20/pubmed PY - 2017/6/7/medline KW - Bacteremia KW - Cefmetazole KW - Cephamycin KW - ESBL KW - Extended spectrum beta-lactamase SP - 427 EP - 427 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 16 IS - 1 N2 - 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. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/27538488/Cefmetazole_for_bacteremia_caused_by_ESBL-producing_enterobacteriaceae_comparing_with_carbapenems L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-1770-1 DB - PRIME DP - Unbound Medicine ER -