Comparison of the efficacy of cefmetazole and meropenem for patients with extended-spectrum beta-lactamase-producing Escherichia coli bacteremia: a single-center experienceTomoyuki Kato1, Emi Ono1, Yoko Hiroshima1, Kaoru Nagata2, Shinichirou Suzaki3, Takashi Yamazaki4, Masayuki Nagasawa1,5
1Antimicrobial Stewardship Team, Musashino Red Cross Hospital, Tokyo, Japan
2Department of General Practice, Musashino Red Cross Hospital, Tokyo, Japan
3Department of Emergency and Critical Care Medicine, Musashino Red Cross Hospital, Tokyo, Japan
4Department of Orthopedics, Musashino Red Cross Hospital, Tokyo, Japan
5Department of Pediatrics, Musashino Red Cross Hospital, Tokyo, Japan
International Medicine 2019; 2(1): 1-6 | DOI: 10.5455/im.56234 PDF
Background: We retrospectively investigated whether cefmetazole (CMZ) was equivalently as effective as meropenem (MEPM) for treating bloodstream infections with extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E. coli).
Methods: From 2012 through 2017, ESBL-E. coli were cultured from the blood of 74 patients at our institute. Excluding 17 ineligible patients, 31 patients were treated with CMZ and 26 patients were treated with MEPM as definitive therapy. The primary infection site was the urinary tract in 37 patients, the abdomen in 4, and undetermined in 16.
Results: There was no significant difference between both groups with respect to sex differences, Sequential Organ Failure Assessment (SOFA) score and Pitt bacteremia score, except for age (CMZ vs. MEPM: 79.5±13.4 vs. 71.4±15.5 years; p=0.045) and the frequency of undetermined infection site (CMZ vs. MEPM: 5/36 vs. 11/26; p=0.028). There was no significant difference in 30-day mortality after treatment between the CMZ and MEPM groups (4/31 vs. 3/26; p=0.88). Furthermore, there was no recurrence within 30 days after treatment in both groups. Multivariate analysis revealed that the SOFA score was significantly (p=0.026) and the undetermined infection focus was relatively (p=0.055) associated with 30-day mortality after treatment.
Conclusions:CMZ for bloodstream infections with ESBL-E. coli originating in the urinary tract may be as effective as MEPM when the SOFA score is not high.
Keywords: bacteremia, beta-lactamase, cefmetazole, meropenem, organ dysfunction score