{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T13:01:28Z","timestamp":1793192488517,"version":"4.5.0"},"reference-count":129,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi260902-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Cefepime is recommended for the treatment of febrile neutropenia and gram-negative infections at moderate risk of ampicillin resistance locus C \u03b2-lactamase production. Concerns regarding cefepime\u2019s safety have been raised in the literature without firm conclusions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260902-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To conduct a systematic review and bayesian random-effects meta-analysis of all randomized clinical trials (RCTs) comparing cefepime with other \u03b2-lactams for all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260902-6\">\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>Cochrane Central Register of Controlled Trials, Medline, Embase, Web of Science, World Health Organization\u2013International Clinical Trials Registry Platform, ClinicalTrials.gov, and LILACS were searched from inception to May 25, 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260902-7\">\n                    <jats:title>Study Selection<\/jats:title>\n                    <jats:p>Randomized clinical trials of children and adults comparing either (1) cefepime monotherapy vs any \u03b2-lactam monotherapy or (2) combination therapy of cefepime and a second drug vs \u03b2-lactam and the same second drug. Studies of prophylactic cefepime or cefepime and \u03b2-lactamase inhibitor combinations were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260902-8\">\n                    <jats:title>Data Extraction and Synthesis<\/jats:title>\n                    <jats:p>This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Two independent reviewers extracted data and assessed the risk of bias using the Cochrane risk-of-bias tool, version 2.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260902-9\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The main outcome was all-cause mortality (30-day or closest reported). Odds of mortality were synthesized using a hierarchical bayesian random-effects model on the log-odds scale. The posterior probabilities of increased mortality (odds ratio [OR] &amp;amp;gt;1) with cefepime for the overall analysis and relevant subgroups were examined. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260902-10\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Synthesis of 110 trials including 22\u202f608 patients (cefepime: 11 726 patients [approximately 56% male]; comparator \u03b2-lactam: 10 882 patients [approximately 56% male]) showed a 94.4% posterior probability that the pooled OR mortality exceeded 1 with cefepime use compared with other \u03b2-lactams (778 [6.6%] vs 674 [6.2%]; OR, 1.10, 95% credible interval, 0.98-1.24). Meta-analysis of published peer-reviewed RCTs (73 trials, 15\u202f411 patients) showed that cefepime was associated with a 98.6% posterior probability of higher mortality compared with other \u03b2-lactams (OR, 1.17; 95% credible interval, 1.02-1.34). Posterior distributions generally favored higher odds of mortality across all comparator \u03b2-lactams, across all clinical indications, and with doses of 2 g or more every 12 hours.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260902-11\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This systematic review and bayesian meta-analysis found that cefepime was associated with higher odds of all-cause mortality compared with other \u03b2-lactams. These findings support a nuanced discussion of cefepime\u2019s safety in guidance statements.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.33017","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:00:29Z","timestamp":1789052429000},"page":"e2633017","source":"Crossref","is-referenced-by-count":2,"title":["Cefepime and Mortality"],"prefix":"10.1001","volume":"9","author":[{"given":"Zahra N.","family":"Sohani","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Medical Microbiology, Department of Medicine, H\u00f4pital Maisonneuve-Rosemont, CIUSSS de l\u2019Est-de-l\u2019\u00cele-de-Montr\u00e9al, Montreal, Quebec, Canada"},{"name":"Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada"},{"name":"Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"You Jia","family":"Zhong","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avideh","family":"Afshar","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bander A.","family":"Assiri","sequence":"additional","affiliation":[{"name":"Division of Clinical and Translational Research, Department of Medicine, McGill University, Montreal, Quebec, Canada"},{"name":"Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi 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Israel"},{"name":"Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur M.","family":"Albuquerque","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Butler-Laporte","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily G.","family":"McDonald","sequence":"additional","affiliation":[{"name":"Schulich Library of Physical Sciences, Life Sciences, and Engineering, Montreal, Quebec, Canada"},{"name":"Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd C.","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"issue":"6","key":"zoi260902r1","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1586\/14787210.6.6.805","article-title":"Cefepime: a reappraisal in an era of increasing antimicrobial resistance.","volume":"6","author":"Endimiani","year":"2008","journal-title":"Expert Rev Anti Infect 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