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Definitive Cefmetazole Therapy for Pediatric ESBL-producing Enterobacterales Bacteremia

Yuto Otsubo1,2, Yo Murata1,2, Kazue Kinoshita3

  • 1From the Division of Infectious Diseases, Immunology, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.

The Pediatric Infectious Disease Journal
|July 16, 2026
PubMed

Insights

Cefmetazole showed comparable outcomes to carbapenems for treating pediatric bacteremia caused by extended-spectrum β-lactamase-producing Enterobacterales. This suggests cefmetazole as a carbapenem-sparing alternative.

Area of Science:

  • Infectious Diseases
  • Pediatric Infectious Diseases
  • Antimicrobial Stewardship

Background:

  • Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales pose a significant threat in pediatric bacteremia.
  • Carbapenems are often the first-line treatment, raising concerns about resistance development.
  • Alternative treatment options are needed to preserve carbapenem efficacy.

Purpose of the Study:

  • To compare the clinical outcomes of cefmetazole versus carbapenems as definitive therapy for pediatric bacteremia.
  • To evaluate cefmetazole as a potential carbapenem-sparing agent.

Main Methods:

  • Retrospective study design.
  • Inclusion of pediatric patients with bacteremia caused by ESBL-producing Enterobacterales.
  • Comparison of clinical outcomes between cefmetazole and meropenem treatment groups.

Main Results:

  • Comparable 30-day mortality rates between cefmetazole and meropenem groups.
  • Similar recurrence rates observed in both treatment arms.
  • Cefmetazole demonstrated non-inferiority to meropenem in this cohort.

Conclusions:

  • Cefmetazole is a viable and effective alternative to carbapenems for treating pediatric ESBL-producing Enterobacterales bacteremia.
  • Cefmetazole can serve as a crucial carbapenem-sparing strategy, aiding antimicrobial stewardship efforts.

Keywords:
ESBL-producing Enterobacteralesbacteremiacefmetazolechildren

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