Abstract
Among all cases of
Enterobacter
bacteremia at 2 academic hospitals over 6 years, we found 100% efficacy of single-agent cefepime at clearing bacteremia ≤1 day and similar rates of in-hospital mortality compared with carbapenems.
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.