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Extended-spectrum beta-lactamases and clinical outcomes: current data.
Reuben Ramphal1, Paul G Ambrose
1Department of Medicine, University of Florida Health Sciences Center, Gainesville, FL 32610, USA. ramphr@medmac.ufl.edu
Summary
Extended-spectrum beta-lactamase (ESBL)-producing bacteria cause difficult-to-treat infections. Cefepime demonstrates high success rates for treating these serious nosocomial infections, offering a valuable therapeutic option.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Nosocomial infections caused by extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacteria present significant therapeutic challenges.
- The precise clinical impact of ESBL carriage on patient morbidity and mortality is not fully elucidated.
- ESBL production appears to have a notable impact on the efficacy of ceftazidime therapy.
Purpose of the Study:
- To critically examine the literature regarding the clinical significance of infections caused by ESBL-producing bacteria.
- To evaluate the effectiveness of different antimicrobial strategies for treating infections caused by ESBL-producing pathogens.
- To assess the role of cefepime in managing serious nosocomial infections.
Main Methods:
- Literature review and critical analysis of existing studies on ESBL-producing bacteria and their treatment.
- Pharmacodynamic analysis comparing cefepime to other antimicrobials based on time above minimum inhibitory concentration (MIC).
- Evaluation of clinical and microbiological success rates for cefepime in treating serious nosocomial infections.
Main Results:
- Cefepime is identified as an effective agent for empirical and directed treatment of ESBL-producing pathogens, showing high success rates in bacteremia, pneumonia, and urinary tract infections.
- Pharmacodynamic targets (70% time above MIC) are more likely to be achieved with cefepime against ESBL-producing Escherichia coli and Klebsiella pneumoniae compared to other antimicrobials.
- No significant difference in time above MIC was observed between ceftazidime and cefepime for non-ESBL-producing strains.
- Appropriate use of cefepime in healthcare settings can reduce overall cephalosporin use, potentially lowering selection pressure for ESBL-producing organisms.
Conclusions:
- Cefepime is a promising therapeutic option for serious nosocomial infections caused by ESBL-producing bacteria.
- Optimizing cefepime dosing is crucial for achieving favorable pharmacodynamic outcomes.
- Judicious use of cefepime may contribute to antimicrobial stewardship by reducing cephalosporin resistance pressure.