Characterization of the Clinical Outcomes With Cefepime in a Neonatal Intensive Care Unit: A Retrospective Cohort Study

Knoderer, Chad A.; Kaylor, David Michael; Toth, Meghan E; Malloy, Katherine M.; Nichols, Kristen R.

doi:10.5863/1551-6776-23.3.209

Cited by 4 publications

(8 citation statements)

References 22 publications

(36 reference statements)

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“…This study showed that cefepime was frequently indicated for complicated urinary tract infections, post‐dialysis complications, and sepsis. These findings are in line with previous studies 15,16,38 …”

Section: Discussionsupporting

confidence: 94%

“…As in a previous study, clinical improvement was significantly associated with appropriate dose, indication, and antibiogram results 16 . In this study, positive clinical outcome was observed in fifty percent of patients despite the inadequate antibiograms and very low adherence to dose and duration of cefepime therapy.…”

Section: Discussionsupporting

confidence: 80%

“…These findings are in line with previous studies. 15,16,38 Antimicrobial susceptibility testing serves as a valuable indicator for the selection of appropriate antibiotic and a predictor of better clinical outcomes. 39 In this study, few patients had been tested for culture and sensitivity which showed a decreased level of testing compared with previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…Cefepime/sulbactam has an extended activity against multidrug‐resistant gram‐negative pathogens 13,14 . Cefepime is indicated for pneumonia, febrile neutropenia, sepsis, urinary tract infections, soft tissue and skin infections and intra‐abdominal infections 15,16 …”

Section: Introductionmentioning

confidence: 99%

“…13,14 Cefepime is indicated for pneumonia, febrile neutropenia, sepsis, urinary tract infections, soft tissue and skin infections and intra-abdominal infections. 15,16 Cefepime has high efficacy and broad therapeutic window where the dose can reach 50 mg/kg to a maximum of 2 g/12 h. Preferably, the dose of 50 mg/kg every 8 hours should be reserved for severe and critical conditions. It is primarily eliminated unchanged in the urine.…”

mentioning

confidence: 99%

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Drug use evaluation of cefepime at Khartoum North Teaching Hospital in Sudan

et al. 2020

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Background Cefepime is essentially used for life‐threatening infections. Although overutilisation of antibiotics is strongly discouraged around the world, they are still overused in developing countries including Sudan. Objectives This study aims to evaluate the rational use of cefepime at Khartoum North Teaching Hospital‐Sudan. Methods A retrospective cross‐sectional, hospital‐based study was conducted in the internal medicine ward at Khartoum North Teaching Hospital from August/2018 to April/2019. The study covered medical records of adult patients receiving cefepime during the study period. Patient's data were analysed using simple descriptive statistics (frequency and percentage) and inferential statistics (logistic regression) to describe the relationship between dependent and independent variables. P ≤ .05 was considered statistically significant. Results Out of 90 patients, only 16.7% of patients were tested for antibiotic sensitivity. Cefepime was prescribed to 50% and 23.3% of patients for the treatment of UTIs/post‐dialysis and sepsis, respectively. Although the majority of patients (72.2%) received cefepime with appropriate indication, only 21.1% and 15.6% received the drug with appropriate dose and duration, respectively. Cefepime had been prescribed appropriately in a correct dose, duration, and indications for only 7.8% of patients. The vast majority of patients tested for kidney functions had elevated creatinine levels (96.1%); however, cefepime dose had been adjusted for only 4.1% of them. Conclusion This study highlighted the irrational use of cefepime regarding inappropriate dose, duration, and inadequate antibiotic sensitivity tests. A lack of attention to dosage adjustment in patients with renal impairment had been observed. Positive clinical outcome was significantly associated with antibiotic sensitivity test.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Drug use evaluation of cefepime at Khartoum North Teaching Hospital in Sudan

et al. 2020

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Potential Antibiotics for the Treatment of Neonatal Sepsis Caused by Multidrug-Resistant Bacteria

et al. 2021

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Neonatal sepsis causes up to an estimated 680,000 deaths annually worldwide, predominantly in low-and middle-income countries (LMICs). A significant and growing proportion of bacteria causing neonatal sepsis are resistant to multiple antibiotics, including the World Health Organization-recommended empiric neonatal sepsis regimen of ampicillin/gentamicin. The Global Antibiotic Research and Development Partnership is aiming to develop alternative empiric antibiotic regimens that fulfil several criteria: (1) affordable in LMIC settings; (2) activity against neonatal bacterial pathogens, including extendedspectrum β-lactamase producers, gentamicin-resistant Gram-negative bacteria, and methicillin-resistant Staphylococcus aureus (MRSA); (3) a licence for neonatal use or extensive experience of use in neonates; and (4) minimal toxicities. In this review, we identify five antibiotics that fulfil these criteria: amikacin, tobramycin, fosfomycin, flomoxef, and cefepime. We describe the available characteristics of each in terms of mechanism of action, resistance mechanisms, clinical pharmacokinetics, pharmacodynamics, and toxicity profile. We also identify some knowledge gaps: (1) the neonatal pharmacokinetics of cefepime is reliant on relatively small and limited datasets, and the pharmacokinetics of flomoxef are also reliant on data from a limited demographic range and (2) for all reviewed agents, the pharmacodynamic index and target has not been definitively established for both bactericidal effect and emergence of resistance, with many assumed to have an identical index/ target to similar class molecules. These five agents have the potential to be used in novel combination empiric regimens for neonatal sepsis. However, the data gaps need addressing by pharmacokinetic trials and pharmacodynamic characterisation. Key PointsAmikacin, tobramycin, fosfomycin, flomoxef, and cefepime are five safe and off-patent antibiotics with experience of use in neonates that can be potentially used as empiric treatment of neonatal sepsis in low-and middle-income settings where antimicrobial resistance complicates current standard-of-care regimens.The neonatal pharmacokinetics are well characterised for most, with cefepime and flomoxef needing some additional data.

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