title: Cefepime vs other antibacterial agents for the treatment of Enterobacter species bacteremia.
abstract: BACKGROUND
  Carbapenems are recommended for treatment of Enterobacter infections with AmpC phenotypes. Although isolates are typically susceptible to cefepime in vitro, there are few data supporting its clinical efficacy.
  
  
  METHODS
  We reviewed all cases of Enterobacter species bacteremia at 2 academic hospitals from 2005 to 2011. Outcomes of interest were (1) persistent bacteremia ≥1 calendar day and (2) in-hospital mortality. We fit logistic regression models, adjusting for clinical risk factors and Pitt bacteremia score and performed propensity score analyses to compare the efficacy of cefepime and carbapenems.
  
  
  RESULTS
  Three hundred sixty-eight patients experienced Enterobacter species bacteremia and received at least 1 antimicrobial agent, of whom 52 (14%) died during hospitalization. Median age was 59 years; 19% were neutropenic, and 22% were in an intensive care unit on the day of bacteremia. Twenty-nine (11%) patients had persistent bacteremia for ≥1 day after antibacterial initiation. None of the 36 patients who received single-agent cefepime (0%) had persistent bacteremia, as opposed to 4 of 16 (25%) of those who received single-agent carbapenem (P < .01). In multivariable models, there was no association between carbapenem use and persistent bacteremia (adjusted odds ratio [aOR], 1.52; 95% CI, .58-3.98; P = .39), and a nonsignificant lower odds ratio with cefepime use (aOR, 0.52; 95% CI, .19-1.40; P = .19). In-hospital mortality was similar for use of cefepime and carbapenems in adjusted regression models and propensity-score matched analyses.
  
  
  CONCLUSIONS
  Cefepime has a similar efficacy as carbapenems for the treatment of Enterobacter species bacteremia. Its use should be further explored as a carbapenem-sparing agent in this clinical scenario.
authors.affiliation: Division of Infectious Diseases.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Siedner
authors.forename: Alicia
authors.initials: A
authors.lastname: Galar
authors.forename: Belisa B
authors.initials: BB
authors.lastname: Guzmán-Suarez
authors.forename: David W
authors.initials: DW
authors.lastname: Kubiak
authors.forename: Nour
authors.initials: N
authors.lastname: Baghdady
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Ferraro
authors.forename: David C
authors.initials: DC
authors.lastname: Hooper
authors.forename: Thomas F
authors.initials: TF
authors.lastname: O'Brien
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Marty
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D015780:Carbapenems / Q000627:therapeutic use*; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use*; D004754:Enterobacter / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D000077723:Cefepime
keywords: Enterobacter; ampC; bacteremia; cefepime; comparative effectiveness