Table 3.
Observational Studies Evaluating Clinical Outcomes of Patients with Extended-Spectrum β-Lactamase Infections Comparing Treatment with Cephamycins versus Carbapenems
| Study | Cephamycin | Carbapenem | Organism(s) | ESBL Criteria | Sites and Sources of Infection | Severity of Illness at Infection Onset | Clinical Outcomes (Cephamycins vs Carbapenems) | Select Limitationsa |
|---|---|---|---|---|---|---|---|---|
| Lee et al [15] | Flomoxef (n = 7) | n = 20 | Klebsiella pneumoniae (100%) | Molecular confirmation | Site: bloodstream (100%) Sources: pneumonia (56%), intra-abdominal (19%), urinary (11%), SSTI (4%) |
52% admitted to ICU | Mortality at 14 d: 29% vs 25% (nsb) | More severely ill patients in carbapenem arm |
| Doi et al [17] | Cefmetazole (n = 10) | n = 12 | Escherichia coli (95%), K. pneumoniae (5%) | Disk diffusion | Site: urine (100%) | Not provided (but likely low) | Clinical cure at 4 weeks: 90% vs 100% (ns) | More patients in carbapenem group with bacteremia or complicated UTI; 90% of patients in cephamycin group received alternative agents initially |
| Yang et al [18] | Flomoxef (n = 29) | n = 28 | K. pneumoniae (100%) | Disk diffusion | Site: bloodstream (100%) Source: fistula, graft, catheter (100%) |
51% admitted to ICU | Mortality at 14 days: 55% vs 39% (P < .05) | Unclear if removal of infected hardware occurred at similar percentages across the 2 treatment groups |
| Pilmis et al [19] | Cefoxitinc (n = 8) | n = 31 |
E. coli (32%), K. pneumoniae (32%), Enterobacter cloacae (36%) |
Not described | Site: urine (75%), bloodstream (25%) | Not provided | Clinical or microbiological relapse at 30 d: 13% vs 23% (ns) | Patients in carbapenem group more likely to be immunocompromised |
| Matsumura et al [20] |
Empiric: cefmetazole or flomoxef (n = 26) Definitive: cefmetazole or flomoxef (n = 59) |
Empiric: n = 45 Definitive: n = 54 |
E. coli (100%) | Disk diffusion | Site: bloodstream (100%) Source: urinary (45%), intra-abdominal (32%) |
41% with severe sepsis | Mortality at 30 d in empiric group: 8% vs 9% (ns) Mortality at 30 d in definitive therapy group: 5% vs 9% (ns) |
Patients in carbapenem group more ill and more likely to be immunocompromised |
Abbreviations: ESBL, extended-spectrum β-lactamase; ICU, intensive care unit; ns, not significant; SSTI, skin and soft tissue infection; UTI, urinary tract infection.
a
Small sample size, residual confounding, and confounding by indication are limitations for all included studies.
b
Not statistically significant using a P value ≤.05.
c
Excluding patients who initially received carbapenems and then converted to cephamycins.