Efficacy and safety of cefepime

Towne, Trent G.; Lewis, James S.; Echevarria, Kelly

doi:10.1016/s1473-3099(08)70288-3

Cited by 13 publications

(5 citation statements)

References 12 publications

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“…A meta-analysis of 57 studies comparing cefepime with another β-lactam antibiotic in more than 3000 patients with sepsis reported an increased risk of all-cause mortality associated with cefepime not long after this study closed recruiting, the greatest difference being between TZP and FEP [12] , [44] . These findings were later disputed [45] and then contradicted [46] , but discrepancies between the original data and the unpublished data submitted by the drug sponsor [47] left the issue unresolved [48] , [49] . Longer cycles or a larger study might have revealed statistically stronger differences.…”

Section: Discussionmentioning

confidence: 99%

The Ecology of Antibiotic Use in the ICU: Homogeneous Prescribing of Cefepime but Not Tazocin Selects for Antibiotic Resistant Infection

et al. 2012

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Background Antibiotic homogeneity is thought to drive resistance but in vivo data are lacking. In this study, we determined the impact of antibiotic homogeneity per se, and of cefepime versus antipseudomonal penicillin/β-lactamase inhibitor combinations (APP-β), on the likelihood of infection or colonisation with antibiotic resistant bacteria and/or two commonly resistant nosocomial pathogens (methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa ). A secondary question was whether antibiotic cycling was associated with adverse outcomes including mortality, length of stay, and antibiotic resistance. Methods We evaluated clinical and microbiological outcomes in two similar metropolitan ICUs, which both alternated cefepime with APP-β in four-month cycles. All microbiological isolates and commensal samples were analysed for the presence of antibiotic-resistant bacteria including MRSA and P. aeruginosa . Results Length of stay, mortality and overall antibiotic resistance were unchanged after sixteen months. However, increased colonisation and infection by antibiotic-resistant bacteria were observed in cefepime cycles, returning to baseline in APP-β cycles. Cefepime was the strongest risk factor for acquisition of antibiotic-resistant infection. Conclusions Ecological effects of different β-lactam antibiotics may be more important than specific activity against the causative agents or the effect of antibiotic homogeneity in selection for antibiotic resistance. This has important implications for antibiotic policy.

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Section: Discussionmentioning

confidence: 99%

The Ecology of Antibiotic Use in the ICU: Homogeneous Prescribing of Cefepime but Not Tazocin Selects for Antibiotic Resistant Infection

et al. 2012

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“…Experts in the field have also raised questions about these and other limitations of the meta-analysis. 11,12 Several other related studies have since been published with conflicting results. A recent study involving a paediatric cohort demonstrated no association between cefepime therapy and increased 30 day mortality in children with acute myelogenous leukaemia when compared with that seen in patients who received other b-lactam antibiotics (cefepime versus ceftazidime: HR 1.33, 95% CI 0.70-2.52; cefepime versus antipseudomonal penicillins: HR 0.86, 95% CI 0.34-2.13; and cefepime versus carbapenems: HR 1.08, 95% CI 0.50-2.35).…”

Section: Discussionmentioning

confidence: 99%

Cefepime effectiveness in Gram-negative bloodstream infections

Al-Hasan

Eckel‐Passow

Baddour

2011

Journal of Antimicrobial Chemotherapy

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Background: We used a retrospective cohort to evaluate the 28 day all-cause mortality in adult patients with Gram-negative bloodstream infection (BSI) who received cefepime therapy compared with those who received other b-lactam antibiotics with in vitro activity against aerobic Gram-negative bacilli. Methods:We identified 398 adult patients who received b-lactam antibiotic monotherapy during hospitalization at Mayo Clinic hospitals in Rochester, MN, USA, for monomicrobial Gram-negative BSI from 1 January 2001 to 31 October 2006. After adjusting for the propensity to receive cefepime, multivariable Cox proportional hazard regression was used to compare the 28 day mortality in patients who were treated with cefepime with that in those who received other b-lactam antibiotics.Results: The median age of patients with Gram-negative BSI was 65 years (interquartile range 51 -77) and 230 (58%) were male. Compared with patients who received other b-lactams, patients treated with cefepime were more likely to have cancer (59% versus 44%, P¼ 0.007) and immunocompromising conditions (55% versus 21%, P,0.001). Patients who received cefepime were less likely to have community-acquired infection acquisition (18% versus 33%, P ¼0.002) and urinary source of BSI (14% versus 23%, P ¼0.04) than those treated with other b-lactam antibiotics. After adjusting for the propensity to receive cefepime and other covariates in the multivariable Cox model, cefepime therapy was not associated with an increased 28 day all-cause mortality (hazard ratio 0.99, 95% confidence interval 0.53 -1.79, P ¼ 0.97). Conclusions:In adult patients with monomicrobial Gram-negative BSI, cefepime therapy was not associated with increased mortality when compared with other b-lactam antibiotics.

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“…Sin embargo, hay que aclarar que el número de pacientes con neoplasia hematológica vs no hematológica (tumor sólido, SIDA y trasplante) es mucho mayor y no es posible establecer una comparación entre ambos grupos. Adicionalmente, los esquemas de quimioterapia en neoplasias hematoló-gicas condicionan mayor tiempo y gravedad de aplasia medular, por lo tanto no se puede diferenciar si el riesgo de mortalidad es debido a la presencia de dicha neoplasia o a su tratamiento quimioterapéutico 31,32 . Towne y cols., al realizar un nuevo análisis de la causa de mortalidad en pacientes tratados con cefepima en NF encontraron que en 36% de un total de 74 casos, ésta estaba relacionada con la progresión de su enfermedad neoplásica 32,33 .…”

Section: Cultivos Negativosunclassified

“…Adicionalmente, los esquemas de quimioterapia en neoplasias hematoló-gicas condicionan mayor tiempo y gravedad de aplasia medular, por lo tanto no se puede diferenciar si el riesgo de mortalidad es debido a la presencia de dicha neoplasia o a su tratamiento quimioterapéutico 31,32 . Towne y cols., al realizar un nuevo análisis de la causa de mortalidad en pacientes tratados con cefepima en NF encontraron que en 36% de un total de 74 casos, ésta estaba relacionada con la progresión de su enfermedad neoplásica 32,33 . En países desarrollados se reportan como etiología de infección en pacientes con NF bacterias grampositivas (60-70%), probablemente por la proliferación del uso de catéteres vasculares centrales 12,19,23,24,29 .…”

Section: Cultivos Negativosunclassified

Características demográficas, morbilidad y mortalidad de los pacientes adultos con neutropenia febril tratados con cefepima

Puentes

Quiroga

Támara

et al. 2012

Rev. chil. infectol.

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Demographics, morbidity, and mortality febrile neutropenic adult patients treated with cefepimeIntroduction: Cefepime efficacy for treatment of febrile neutropenia (FN) in cancer adult patients is a controversial issue. Objective: To describe the demographic characteristics and general mortality of patients suffering from febrile neutropenia treated with cefepime in a fourth-level Latin American hospital. Patients and Methods: A cross-sectional observational study was performed. Study settled at San Ignacio of Bogotá, Colombia. University Hospital from January 2004 to December 2008. Results: A total of 333 patients were treated with cefepime, of whom 125 had suffered FN and met pre established inclusion and exclusion criteria. The general mortality was 14.4%, which was similar to the overall mortality in FN in other reports. Conclusions: Although there is still no clarity regarding the efficacy of cefepime in FN, its use has not been restricted. This study did not identify an excess risk of mortality in patients treated with cefepime.

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Efficacy and safety of cefepime

Cited by 13 publications

References 12 publications

The Ecology of Antibiotic Use in the ICU: Homogeneous Prescribing of Cefepime but Not Tazocin Selects for Antibiotic Resistant Infection

The Ecology of Antibiotic Use in the ICU: Homogeneous Prescribing of Cefepime but Not Tazocin Selects for Antibiotic Resistant Infection

Cefepime effectiveness in Gram-negative bloodstream infections

Características demográficas, morbilidad y mortalidad de los pacientes adultos con neutropenia febril tratados con cefepima

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