Efficacy of cefoxitin versus carbapenem in febrile male urinary tract infections caused by extended spectrum beta-lactamase–producing Escherichia coli: a multicenter retrospective cohort study with propensity score analysis

Carbapenem-Sparing Strategies for ESBL Producers: When and How

“…In the majority of the studies, no difference regarding mortality was observed [49,[51][52][53]55,56] with the exception of two studies [50,54]. The major drawbacks of the studies were the small population size, inadequate control for confounders and low statistical power, whereas carbapenems were administrated in more severe infections and mostly in bacteremic patients [49][50][51][52][53][54][55][56]. Lee et al [54] found similar mortality rates with flomoxef and carbapenems when the MIC of flomoxef was ≤1 mg/L, but when MIC was 4-8 mg/L, cefoxitin was found inferior to carbapenem.…”

“…However, cephamycins are not active against AmpC cephalosporinases and porin mutations [48]. Eight observational studies comparing the efficacy of cephamycins and carbapenems in infections (mainly UTIs and bacteremia) due to ESBL-PE have been published to date and are illustrated in Table 2 [49][50][51][52][53][54][55][56]. In the majority of the studies, no difference regarding mortality was observed [49,[51][52][53]55,56] with the exception of two studies [50,54].…”

“…Eight observational studies comparing the efficacy of cephamycins and carbapenems in infections (mainly UTIs and bacteremia) due to ESBL-PE have been published to date and are illustrated in Table 2 [49][50][51][52][53][54][55][56]. In the majority of the studies, no difference regarding mortality was observed [49,[51][52][53]55,56] with the exception of two studies [50,54]. The major drawbacks of the studies were the small population size, inadequate control for confounders and low statistical power, whereas carbapenems were administrated in more severe infections and mostly in bacteremic patients [49][50][51][52][53][54][55][56].…”

“…No significant difference was illustrated for clinical and microbiological success between the two groups in univariate and multivariable models. An interesting point was that cefoxitin administrated at high dose and continuous infusion was associated with clinical success [56]. Table 2.…”

“…Table 2. Clinical studies comparing the efficacy of cephamycins versus carbapenems in infections caused by ESBL-producing Enterobacterales [49][50][51][52][53][54][55][56]. The available data suggest that cephamycins may be an alternative to carbapenems for some non-severe infections, particularly UTIs, and should be administrated at high dose and continuous infusion.…”