{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T02:59:51Z","timestamp":1789095591153,"version":"build-2803163510"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T00:00:00Z","timestamp":1674604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Limited data suggest that serious infections caused by Enterobacterales with a moderate to high risk of clinically significant AmpC production can be successfully treated with cefepime if the cefepime minimum inhibitory concentration (MIC) is \u22642\u2005\u00b5g\/mL. However, isolates with a cefepime-susceptible dose-dependent (SDD) MIC of 4\u20138\u2005\u00b5g\/mL should receive a carbapenem due to target attainment and extended-spectrum \u03b2-lactamase (ESBL) concerns.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective cohort study of hospitalized patients with E. cloacae, K. aerogenes, or C. freundii bacteremia from January 2015 to March 2022 receiving high-dose cefepime or a carbapenem. Cox regression models were used with incorporation of inverse probability of treatment weighting and time-varying covariates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 315 patients included, 169 received cefepime and 146 received a carbapenem (ertapenem n = 90, meropenem n = 56). Cefepime was not associated with an increased risk of 30-day mortality compared with carbapenem therapy (adjusted hazard ratio [aHR], 1.45; 95% CI, 0.79\u20132.14), which was consistent for patients with cefepime SDD isolates (aHR, 1.19; 95% CI, 0.52\u20131.77). Multivariable weighted Cox models identified Pitt bacteremia score &amp;gt;4 (aHR, 1.41; 95% CI, 1.04\u20131.92), deep infection (aHR, 2.27; 95% CI, 1.21\u20134.32), and ceftriaxone-resistant AmpC-E (aHR, 1.32; 95% CI, 1.03\u20131.59) to be independent predictors associated with increased mortality risk, while receipt of prolonged-infusion \u03b2-lactam was protective (aHR, 0.67; 95% CI, 0.40\u20130.89).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among patients with bacteremia caused by Enterobacterales with moderate to high risk of clinically significant AmpC production, these data demonstrate similar risk of 30-day mortality for high-dose cefepime or a carbapenem as definitive \u03b2-lactam therapy.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ofid\/ofad034","type":"journal-article","created":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T01:57:25Z","timestamp":1674784645000},"source":"Crossref","is-referenced-by-count":23,"title":["High-dose Cefepime vs Carbapenems for Bacteremia Caused by Enterobacterales With Moderate to High Risk of Clinically Significant AmpC \u03b2-lactamase Production"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4891-8625","authenticated-orcid":false,"given":"Ashlan J","family":"Kunz Coyne","sequence":"first","affiliation":[{"name":"Wayne State University , Detroit, Michigan , USA"},{"name":"Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University , Detroit, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1744-0048","authenticated-orcid":false,"given":"Amer","family":"El Ghali","sequence":"additional","affiliation":[{"name":"Wayne State University , Detroit, Michigan , USA"},{"name":"Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University , Detroit, Michigan , 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USA"},{"name":"Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University , Detroit, Michigan , USA"},{"name":"Department of Clinical & Administrative Pharmacy Sciences, Howard University College of Pharmacy , Washington, DC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7171-7015","authenticated-orcid":false,"given":"Dana J","family":"Holger","sequence":"additional","affiliation":[{"name":"Wayne State University , Detroit, Michigan , USA"},{"name":"Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University , Detroit, Michigan , USA"},{"name":"Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy , Davie, Florida , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5967-5211","authenticated-orcid":false,"given":"Michael 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