Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world study
Abstract Background This investigation aimed to compare the efficacy of cefepime and carbapenem for complicated urinary tract infection (cUTI) caused by presumptive AmpC β-lactamase-producing Enterobacter spp., Serratia marcescens, Citrobacter freundii, Providencia spp., and Morganella morganii (ESC...
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BMC
2025-03-01
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| Online Access: | https://doi.org/10.1186/s12879-025-10850-5 |
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| author | Liang Chen Jie Hua Xiaopu He |
| author_facet | Liang Chen Jie Hua Xiaopu He |
| author_sort | Liang Chen |
| collection | DOAJ |
| description | Abstract Background This investigation aimed to compare the efficacy of cefepime and carbapenem for complicated urinary tract infection (cUTI) caused by presumptive AmpC β-lactamase-producing Enterobacter spp., Serratia marcescens, Citrobacter freundii, Providencia spp., and Morganella morganii (ESCPM). Methods Data of 458 individuals with cUTI caused by cefoxitin-nonsusceptible [minimum inhibitory concentration (MIC) > 8 µg/mL] and cefepime-susceptible (MIC ≤ 2 µg/mL) ESCPM was acquired from four Chinese hospitals between 2010 and 2022 and were reviewed retrospectively. Results 125 and 333 patients received cefepime and carbapenems, respectively, as antimicrobial therapy. The 28-day treatment failure rate was 15.7% (72/458). The following factors were identified as independent predictors for 28-day therapy: age, cefepime MIC = 2 µg/mL, immunocompromised status, infection source control, appropriate empirical therapy, and days from illness onset to active therapy. In patients who required cefepime MIC ≤ 1 µg/mL, a multivariate logistic model indicated that cefepime was linked with a similar risk of 28-day treatment failure [odd ratio (OR) 1.791, 95% confidence interval (CI) 0.600–5.350, p = 0.296] compared with carbapenems after controlling these predictors. Compared with individuals with cefoxitin-nonsusceptible ESCPM, those with isolates of cefepime (MIC = 2 µg/mL) had an enhanced risk of 28-day treatment failure (OR = 2.579, 95% CI = 1.012–6.572, p = 0.047). A propensity score for treatment analysis validated this relationship. Conclusions The cefepime and carbapenem had comparable efficacy for treating cUTI caused by cefoxitin-nonsusceptible ESCPM organisms with cefepime MIC ≤ 1 µg/mL, whereas carbapenems are potentially more effective for isolates with cefepime MIC = 2 µg/mL. |
| format | Article |
| id | doaj-art-c34ecb3c0151432d9a4aeda4bbb75abc |
| institution | OA Journals |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
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| series | BMC Infectious Diseases |
| spelling | doaj-art-c34ecb3c0151432d9a4aeda4bbb75abc2025-08-20T01:53:11ZengBMCBMC Infectious Diseases1471-23342025-03-0125111110.1186/s12879-025-10850-5Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world studyLiang Chen0Jie Hua1Xiaopu He2Department of Infectious Diseases, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical College of Nanjing UniversityDepartment of Gastroenterology, The First Affiliated Hospital of Nanjing Medical UniversityDepartment of Geriatric Gastroenterology, The First Affiliated Hospital of Nanjing Medical UniversityAbstract Background This investigation aimed to compare the efficacy of cefepime and carbapenem for complicated urinary tract infection (cUTI) caused by presumptive AmpC β-lactamase-producing Enterobacter spp., Serratia marcescens, Citrobacter freundii, Providencia spp., and Morganella morganii (ESCPM). Methods Data of 458 individuals with cUTI caused by cefoxitin-nonsusceptible [minimum inhibitory concentration (MIC) > 8 µg/mL] and cefepime-susceptible (MIC ≤ 2 µg/mL) ESCPM was acquired from four Chinese hospitals between 2010 and 2022 and were reviewed retrospectively. Results 125 and 333 patients received cefepime and carbapenems, respectively, as antimicrobial therapy. The 28-day treatment failure rate was 15.7% (72/458). The following factors were identified as independent predictors for 28-day therapy: age, cefepime MIC = 2 µg/mL, immunocompromised status, infection source control, appropriate empirical therapy, and days from illness onset to active therapy. In patients who required cefepime MIC ≤ 1 µg/mL, a multivariate logistic model indicated that cefepime was linked with a similar risk of 28-day treatment failure [odd ratio (OR) 1.791, 95% confidence interval (CI) 0.600–5.350, p = 0.296] compared with carbapenems after controlling these predictors. Compared with individuals with cefoxitin-nonsusceptible ESCPM, those with isolates of cefepime (MIC = 2 µg/mL) had an enhanced risk of 28-day treatment failure (OR = 2.579, 95% CI = 1.012–6.572, p = 0.047). A propensity score for treatment analysis validated this relationship. Conclusions The cefepime and carbapenem had comparable efficacy for treating cUTI caused by cefoxitin-nonsusceptible ESCPM organisms with cefepime MIC ≤ 1 µg/mL, whereas carbapenems are potentially more effective for isolates with cefepime MIC = 2 µg/mL.https://doi.org/10.1186/s12879-025-10850-5CefepimeCarbapenemComplicated urinary tract infection (cUTI)AmpC β-lactamaseESCPMCefoxitin-nonsusceptible |
| spellingShingle | Liang Chen Jie Hua Xiaopu He Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world study BMC Infectious Diseases Cefepime Carbapenem Complicated urinary tract infection (cUTI) AmpC β-lactamase ESCPM Cefoxitin-nonsusceptible |
| title | Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world study |
| title_full | Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world study |
| title_fullStr | Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world study |
| title_full_unstemmed | Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world study |
| title_short | Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world study |
| title_sort | cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin nonsusceptible escpm organisms a multicenter real world study |
| topic | Cefepime Carbapenem Complicated urinary tract infection (cUTI) AmpC β-lactamase ESCPM Cefoxitin-nonsusceptible |
| url | https://doi.org/10.1186/s12879-025-10850-5 |
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