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Clinical Impact of Revised Cefepime Breakpoint in Patients With Enterobacteriaceae Bacteremia

Kap Sum Foong1, Abigail L Carlson2,3, Satish Munigala2

  • 1Section of Infectious Diseases, Department of Medicine, University of Peoria, Peoria, Illinois., St Louis, Missouri.

Open Forum Infectious Diseases
|October 30, 2019
PubMed

Insights

The revised Clinical and Laboratory Standards Institute (CLSI) criteria for cefepime did not affect outcomes in Enterobacteriaceae infections. Mortality and treatment failure rates remained unchanged, even with updated susceptibility interpretations.

Area of Science:

  • Clinical microbiology
  • Antimicrobial stewardship
  • Infectious diseases

Background:

  • The Clinical and Laboratory Standards Institute (CLSI) updated interpretative criteria for cefepime.
  • The clinical impact of these revised cefepime breakpoints on Enterobacteriaceae infections is not well understood.

Purpose of the Study:

  • To evaluate the impact of the new CLSI cefepime breakpoints on clinical and microbiological outcomes in Enterobacteriaceae infections.

Main Methods:

  • Retrospective analysis of 644 Enterobacteriaceae isolates previously defined as cefepime-susceptible.
  • Application of the revised CLSI cefepime breakpoint criteria to these isolates.
  • Comparison of patient outcomes (mortality, microbiological failure) based on susceptibility classification under old and new criteria.

Main Results:

  • No significant differences in mortality were observed between isolates classified as susceptible or susceptible-dose dependent by current criteria.
  • Microbiological failure rates were also similar regardless of the updated cefepime susceptibility interpretation.
  • The revised CLSI breakpoints did not alter the assessment of clinical outcomes for cefepime in this cohort.

Conclusions:

  • The revised CLSI interpretative criteria for cefepime do not appear to significantly impact clinical or microbiological outcomes in Enterobacteriaceae infections.
  • Clinicians can likely continue current treatment strategies for Enterobacteriaceae infections based on established cefepime susceptibility data.
Keywords:
CLSIEnterobacteriaceaebacteremiacefepimecefepime-susceptible dose-dependentsusceptibility

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