title: High-dose cefepime as an alternative treatment for infections caused by TEM-24 ESBL-producing Enterobacter aerogenes in severely-ill patients.
abstract: This study evaluated retrospectively the efficacy of treatment with cefepime vs. a carbapenem, in combination with amikacin or ciprofloxacin, for seriously-ill patients infected with ESBL-producing Enterobacter aerogenes who were admitted to an intensive care unit. Forty-four episodes of infection were investigated in 43 patients: 21 treated with cefepime; 23 with a carbapenem. The two treatment groups did not differ statistically in terms of age, APACHE II scores, and infection sites, but the average duration of antibiotic exposure was significantly shorter in the cefepime group (8.5 days vs. 11.4 days; p 0.04). Clinical improvement was seen in 62% of patients receiving cefepime vs. 70% of patients receiving a carbapenem (p 0.59). Bacteriological eradication was achieved in 14% of patients receiving cefepime vs. 22% of patients receiving a carbapenem (p 0.76). The 30-day mortality rates related to infection were 33% in the cefepime group and 26% in the carbapenem group (p 0.44). Thus, outcome parameters did not differ significantly between the two groups. Nevertheless, a statistically significant increase in failure to eradicate ESBL-producing E. aerogenes was observed as the MICs of cefepime rose (p 0.017). Pulsed-field gel electrophoresis revealed three distinct clones, but one predominant clone harbouring the bla(TEM-24) gene was associated with most (42/44) of the episodes of infection. It was concluded that cefepime may be an alternative agent for therapy of severe infections caused by TEM-24 ESBL-producing E. aerogenes, although further studies are required to confirm these observations.
authors.affiliation: Department of Microbiology, University Hospital of Antwerp, Edegem, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Goethaert
authors.forename: M
authors.initials: M
authors.lastname: Van Looveren
authors.forename: C
authors.initials: C
authors.lastname: Lammens
authors.forename: H
authors.initials: H
authors.lastname: Jansens
authors.forename: A
authors.initials: A
authors.lastname: Baraniak
authors.forename: M
authors.initials: M
authors.lastname: Gniadkowski
authors.forename: K
authors.initials: K
authors.lastname: Van Herck
authors.forename: P G
authors.initials: PG
authors.lastname: Jorens
authors.forename: H E
authors.initials: HE
authors.lastname: Demey
authors.forename: M
authors.initials: M
authors.lastname: Ieven
authors.forename: L
authors.initials: L
authors.lastname: Bossaert
authors.forename: H
authors.initials: H
authors.lastname: Goossens
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000096:biosynthesis*; D015780:Carbapenems / Q000008:administration & dosage / Q000627:therapeutic use; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage* / Q000627:therapeutic use; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D004359:Drug Therapy, Combination; D021902:Enterobacter aerogenes / Q000187:drug effects / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D002511:Cephalosporins; D000077723:Cefepime; C121000:TEM24 beta-lactamase; D001618:beta-Lactamases