Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy · 2026
Definitive cefepime versus carbapenems for bacteremia caused by Enterobacterales with a risk of chromosomal AmpC production in children.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Shoji Takashi, Otsubo Yuto, Horikoshi Yuho
Аннотация
BACKGROUND: In adults, cefepime is proposed as a treatment option for infections associated with a risk of AmpC β-lactamase overproduction; however, data in pediatric populations are limited. We aimed to compare clinical outcomes between cefepime versus carbapenem as definitive therapy for bacteremia caused by Enterobacterales with a relatively high risk of chromosomal AmpC production (AmpC-E) in children.
METHODS: This retrospective cohort study was conducted at a tertiary children's hospital between 2010 and 2024. Eligible patients were <21 years old with blood cultures positive for AmpC-E. The primary outcome was 30-day mortality. Secondary outcomes included 30-day recurrence, time to negative blood culture and treatment-related toxicity.
RESULTS: 51 children met the inclusion criteria. The median age was 11 months (IQR: 3-63), with 54.9% male patients. Cefepime and meropenem were administered as definitive therapy in 38 (74.5%) and 13 (25.5%) cases. Baseline characteristics of the patients were comparable. Isolated organisms included Enterobacter cloacae complex (47.1%), Serratia marcescens (29.4%) and Klebsiella aerogenes (19.6%). The cefepime group had a higher prevalence of Klebsiella aerogenes (26.3%, p = 0.048) and Serratia marcescens (39.5%, p = 0.006). The 30-day mortality was 2.6% (1/38) in the cefepime group and 15.4% (2/13) in the meropenem group (p = 0.156). No recurrence of bacteremia or treatment-related toxicity were observed. The median time to negative blood cultures was 2 days (IQR: 1-3) in the cefepime group and 1 day (IQR: 1-5) in the meropenem group (p = 0.949).
CONCLUSION: Cefepime and meropenem as definitive therapy demonstrated comparable outcomes for AmpC-E bacteremia. Further prospective studies are warranted.
METHODS: This retrospective cohort study was conducted at a tertiary children's hospital between 2010 and 2024. Eligible patients were <21 years old with blood cultures positive for AmpC-E. The primary outcome was 30-day mortality. Secondary outcomes included 30-day recurrence, time to negative blood culture and treatment-related toxicity.
RESULTS: 51 children met the inclusion criteria. The median age was 11 months (IQR: 3-63), with 54.9% male patients. Cefepime and meropenem were administered as definitive therapy in 38 (74.5%) and 13 (25.5%) cases. Baseline characteristics of the patients were comparable. Isolated organisms included Enterobacter cloacae complex (47.1%), Serratia marcescens (29.4%) and Klebsiella aerogenes (19.6%). The cefepime group had a higher prevalence of Klebsiella aerogenes (26.3%, p = 0.048) and Serratia marcescens (39.5%, p = 0.006). The 30-day mortality was 2.6% (1/38) in the cefepime group and 15.4% (2/13) in the meropenem group (p = 0.156). No recurrence of bacteremia or treatment-related toxicity were observed. The median time to negative blood cultures was 2 days (IQR: 1-3) in the cefepime group and 1 day (IQR: 1-5) in the meropenem group (p = 0.949).
CONCLUSION: Cefepime and meropenem as definitive therapy demonstrated comparable outcomes for AmpC-E bacteremia. Further prospective studies are warranted.