Clinical Outcomes of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Infections with Susceptibilities among Levofloxacin, Cefepime, and Carbapenems

• Published in: The Canadian journal of infectious diseases & medical microbiology Vol. 2018; no. 2018; pp. 1 - 6
• Main Authors: Walker, Kristy J., Klar, Amanda R., Lee, Young R.
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Publishing Corporation 01-01-2018; Hindawi; John Wiley & Sons, Inc; Hindawi Limited
• Subjects: Antibiotics; Antimicrobial agents; Bacteria; Bacterial diseases; Bacterial infections; Beta lactamases; Carbapenems; Cefepime; Chemotherapy; Clinical outcomes; Clinical trials; Development and progression; Disease susceptibility; E coli; Enterobacteriaceae; Family medical history; Gram-negative bacteria; Health sciences; Infection; Infections; Infectious diseases; Laboratories; Levofloxacin; Medical research; Medicine, Experimental; Microbiology; Mortality; Organisms; Patient outcomes; Patients; Pharmacy; Pneumonia; Production methods; Risk factors; Statistical analysis; Systematic review; Trends; β Lactamase; United States > US; Texas
• ISSN: 1712-9532; 1918-1493
• DOI: 10.1155/2018/3747521

Purpose. Highly resistant Gram-negative bacterial infections are associated with high mortality. Increasing resistance to standard therapy illustrates the need for alternatives when treating resistant organisms, especially extended-spectrum beta-lactamase- (ESBL-) producing Enterobacteriaceae. Methods. A retrospective chart review at a community hospital was performed. Patients who developed ESBL-producing infections were included. Patients less than eighteen years old, who were pregnant, or who were incarcerated were excluded. The primary outcome was hospital mortality. The secondary outcomes included intensive care unit (ICU) mortality, ICU length of stay, and hospital length of stay. Results. 113 patients with ESBL-producing infections met the criteria for review. Hospital mortality: carbapenem (16.6%), cefepime (0%), and levofloxacin (15.3%) (p=0.253). ICU mortality: carbapenem (4.5%), cefepime, (0%), and levofloxacin (3.7%) (p=0.616). Mean ICU and hospital length of stay: carbapenem (9.8 ± 16, 12.1 ± 1 days), cefepime (7.8 ± 6, 11.1 ± 10.5 days), and levofloxacin (5.4 ± 4.1, 11.1 ± 10.4 days) (p=0.805,0.685). No predictors were clearly found between the source of infection and mortality. Conclusion. Cefepime or levofloxacin can be a potential alternative agent for infections with ESBL-producing Enterobacteriaceae, and larger clinical trials investigating these outcomes are warranted.