Cefmetazole for bacteremia caused by ESBL-producing enterobacteriaceae comparing with carbapenems

摘要

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.