Clinical Outcomes in Patients With Gram-Negative Infections Treated With Optimized Dosing Cefepime Over Various Minimum Inhibitory Concentrations

Altshuler, Jerry; Guervil, David J.; Ericsson, Charles D.; Wanger, Audrey; Aitken, Samuel L; Ostrosky-Zeichner, Luis

doi:10.1177/0897190017696950

Cited by 9 publications

(9 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, despite in vitro activity, cefepime appears to be suboptimal and cannot be recommended as definitive therapy. Taken together with the findings of other studies showing the increased failure of cefepime for the treatment of infections caused by ESBL-producing Enterobacteriaceae and/or those with MICs in the susceptible dose-dependent range, like two-thirds of the isolates in this study, the adequacy of the recently revised CLSI cefepime breakpoints may be called into question (18,19). Second, none of the 21 patients who received empiric therapy with piperacillin-tazobactam died, including 3 who never received carbapenem therapy.…”

Section: Figmentioning

confidence: 59%

Carbapenem versus Cefepime or Piperacillin-Tazobactam for Empiric Treatment of Bacteremia Due to Extended-Spectrum-β-Lactamase-Producing Escherichia coli in Patients with Hematologic Malignancy

Benanti

Brown

Shigle

et al. 2019

Antimicrob Agents Chemother

Self Cite

View full text Add to dashboard Cite

Infections with extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli are common in patients with hematologic malignancy. The utility of cefepime and piperacillin-tazobactam as empiric therapy for ESBL-producing E. coli bacteremia in patients with hematologic malignancy is largely unknown. We conducted a single-center, retrospective cohort review of 103 adult inpatients with leukemia and/or hematopoietic stem cell transplant (HCT) recipients with monomicrobial ESBL-producing E. coli bacteremia. No association between increased 14-day mortality and empiric treatment with cefepime (8%) or piperacillin-tazobactam (0%) relative to that with carbapenems (19%) was observed (P = 0.19 and P = 0.04, respectively). This observation was consistent in multivariate Cox proportional hazards models adjusted for confounding and an inverse probability of treatment-weighted (IPTW) Cox proportional hazards model. Both fever and persistent bacteremia were more common in patients treated empirically with cefepime or piperacillin-tazobactam. Empiric treatment with cefepime or piperacillin-tazobactam did not result in increased mortality relative to that with treatment with carbapenems in patients with hematologic malignancy and ESBL-producing E. coli bacteremia, although most patients were changed to carbapenems early in treatment. However, due to prolonged fever and persistent bacteremia, their role may be limited in this patient population.

show abstract

Section: Figmentioning

confidence: 59%

Carbapenem versus Cefepime or Piperacillin-Tazobactam for Empiric Treatment of Bacteremia Due to Extended-Spectrum-β-Lactamase-Producing Escherichia coli in Patients with Hematologic Malignancy

Benanti

Brown

Shigle

et al. 2019

Antimicrob Agents Chemother

Self Cite

View full text Add to dashboard Cite

show abstract

“…21 A recent study evaluating clinical outcomes in patients with Gram-negative bacteremia or pneumonia treated with various cefepime dosing strategies identified that elevated MICs (4–8 µg/mL) were independently associated with clinical failure; however, utilization of high-dose cefepime, which included 1 g q6h or 2 g q8h regimens, was associated with a trend towards lower rates of clinical failure. 25 Although this study does not aim to compare outcomes between the two high-dose cefepime regimens we compare in our study, it does support the use of 1 g q 6 h as a high-dose strategy as an alternative to 2 g q8h. Helgeson et al.…”

Section: Discussionmentioning

confidence: 80%

Impact of a cefepime shortage on dosing regimens and outcomes in hospitalized adults with febrile neutropenia

Haiduc

Patel

Walsh

et al. 2020

J Oncol Pharm Pract

View full text Add to dashboard Cite

Background Drug shortages may negatively impact outcomes in hospitalized patients. A cefepime dosing regimen of 1 gram every 6 hours (1 g q6h) has shown to provide similar exposures above target minimum inhibitory concentrations compared to the regimen of 2 g q8h approved by the United States Food and Drug Administration (FDA) for febrile neutropenia. Our objective was to determine if the dosing regimen of 1 g q6h amidst a cefepime shortage is an appropriate alternative for the treatment of febrile neutropenia. Methods A retrospective chart review of hospitalized patients who received cefepime for febrile neutropenia over a two-year period was performed. Patients were grouped based on cefepime dosing strategy: 2 g q8h vs. 1 g q6h. The primary objective was to compare time to defervescence after cefepime initiation. Secondary objectives included all-cause 30-day mortality, duration of antibiotic therapy, and inpatient length of stay. Results Seventy-five patients in each arm were included. There were no differences in baseline age or severity of illness between groups. There was no difference in the primary objective as median time to defervescence was similar between the 2 g q8h and 1 g q6h groups (69.0 vs. 65.3 h: p= 0.67). Additionally, no differences were found in the secondary objectives of all-cause 30-day mortality (10.7% vs. 9.3%: p = 0.79), duration of therapy (80.8 vs. 88.0 h: p = 0.34), or length of stay (9 vs. 7 days: p = 0.50). Conclusions Our study identified no differences in clinical outcomes with cefepime 1 g q6h compared to the traditional FDA-approved 2 g q8h regimen for the treatment of febrile neutropenia.

show abstract

“…These findings support the findings of previous studies comparing these dosing regimens for febrile neutropenia cancer patients. 9,11–13…”

Section: Discussionmentioning

confidence: 99%

Smaller but more frequent dosing of cefepime in the treatment of febrile neutropenia

Okubo

Andrick

Rampulla

et al. 2022

J Oncol Pharm Pract

View full text Add to dashboard Cite

Background Generally national guidelines for febrile neutropenia recommend treatment with cefepime 2 g every 8 h. Due to beta-lactam’s time dependent killing effects, it is hypothesized smaller doses given more frequently might be non-inferior. The objective of this study is to retrospectively evaluate the efficacy of cefepime 1 g every 6 h versus 2 g every 8 h in cancer patients with febrile neutropenia. Methods This retrospective, single-center, cohort study included patients with a diagnosis of febrile neutropenia treated with cefepime during an inpatient encounter. Patients were grouped based on receipt of cefepime 2 g every 8 h (high dose cohort) versus cefepime 1 g every 6 h (low dose cohort). The primary outcome compared the time to defervescence after cefepime initiation between the two dosing strategies. A subgroup analysis of the primary endpoint was conducted in patients who received both cefepime and vancomycin. Results Ninety-seven patients were included in the high dose cohort, and seventy-six patients were included in the low dose cohort. Baseline characteristics were similar between cohorts with the exception of race. The time to defervescence between the high dose cohort and low dose cohort were comparable between groups (49.2 vs. 46.7 h). The time to defervescence in subgroup analysis of patients who received empiric vancomycin and cefepime was 65.7 versus 59.7. Conclusion Patients who received cefepime 1 g every 6 h were found to have similar trends in achieving time to defervescence compared to 2 g every 8 h.

show abstract

Clinical Outcomes in Patients With Gram-Negative Infections Treated With Optimized Dosing Cefepime Over Various Minimum Inhibitory Concentrations

Cited by 9 publications

References 15 publications

Carbapenem versus Cefepime or Piperacillin-Tazobactam for Empiric Treatment of Bacteremia Due to Extended-Spectrum-β-Lactamase-Producing Escherichia coli in Patients with Hematologic Malignancy

Carbapenem versus Cefepime or Piperacillin-Tazobactam for Empiric Treatment of Bacteremia Due to Extended-Spectrum-β-Lactamase-Producing Escherichia coli in Patients with Hematologic Malignancy

Impact of a cefepime shortage on dosing regimens and outcomes in hospitalized adults with febrile neutropenia

Smaller but more frequent dosing of cefepime in the treatment of febrile neutropenia

Contact Info

Product

Resources

About