{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:58:14Z","timestamp":1785419894111,"version":"3.56.0"},"reference-count":13,"publisher":"American Society for Microbiology","issue":"6","license":[{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["ASM Case Rep"],"published-print":{"date-parts":[[2025,11,4]]},"abstract":"ABSTRACT<\/jats:title>\n \n \n \n Background<\/jats:title>\n \n The growing incidence of carbapenem-resistant Enterobacterales (CRE) poses a challenge to clinical practice. Despite some\n Klebsiella pneumoniae<\/jats:italic>\n carbapenemase (KPC)-positive Enterobacterales testing as susceptible to cefepime,\n in vivo<\/jats:italic>\n data show that cefepime is not a reliable treatment option for infections caused by carbapenemase-producing CRE (CP-CRE). Contemporary guidance recommends against cefepime use for the treatment of KPC-positive infections; however, the clinical implications of this practice are unknown.\n <\/jats:p>\n <\/jats:sec>\n \n Case Summary<\/jats:title>\n \n Here, we present a case of clinical failure after cefepime treatment for a KPC-producing\n Escherichia coli<\/jats:italic>\n urinary tract infection that tested as cefepime-susceptible\n in vitro<\/jats:italic>\n that was successfully treated with ceftazidime\/avibactam. This case is concordant with the\n in vivo<\/jats:italic>\n PKPD findings that the presence of KPC blunted the microbiologic activity of human-simulated cefepime exposures despite MICs that would suggest susceptible or susceptible dose-dependent (SDD) interpretation.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This case adds to the growing literature supporting the use of carbapenemase testing for Enterobacterales isolates that demonstrate resistance to one or more carbapenems to guide therapy. Until confirmatory clinical data are available, clinicians and laboratorians must consider selective reporting or other strategies in the setting of contradictory phenotypic susceptibility data and genotypic resistance markers.<\/jats:p>\n <\/jats:sec>\n <\/jats:sec>","DOI":"10.1128\/asmcr.00094-25","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T13:40:03Z","timestamp":1753969203000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":2,"title":["Cefepime failure for the treatment of cefepime-susceptible, KPC-producing\n Escherichia coli<\/i>\n emphysematous cystitis"],"prefix":"10.1128","volume":"1","author":[{"given":"Jordynne","family":"Morelan","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01p7jjy08","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Pharmacy, SSM Health Saint Louis University Hospital","place":["St. Louis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Hou","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01p7jjy08","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Internal Medicine, Saint Louis University","place":["St. Louis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Chamberland","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01p7jjy08","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Pathology, Saint Louis University","place":["St. Louis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3606-0761","authenticated-orcid":true,"given":"Christian M.","family":"Gill","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01p7jjy08","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Pharmacy, SSM Health Saint Louis University Hospital","place":["St. Louis, USA"]},{"id":[{"id":"https:\/\/ror.org\/01p7jjy08","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Internal Medicine, Saint Louis University","place":["St. Louis, USA"]},{"id":[{"id":"https:\/\/ror.org\/00gt5xe03","id-type":"ROR","asserted-by":"publisher"}],"name":"Center for Anti-Infective Research and Development, Hartford Hospital","place":["Hartford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix893"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa122"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae403"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01474-24"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-019-03711-y"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkad229"},{"key":"e_1_3_1_8_2","volume-title":"M100","author":"CLSI","year":"2025","unstructured":"CLSI. 2025. Performance standards for antimicrobial susceptibility testing. In M100, Thirty-Fifth Edition"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2020.01.005"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2017.62"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac354"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae273"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01271-20"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00138-20"}],"container-title":["ASM Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/asmcr.00094-25","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/asmcr.00094-25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T13:00:45Z","timestamp":1762261245000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/asmcr.00094-25"}},"subtitle":[],"editor":[{"given":"Nicholas M.","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,4]]},"references-count":13,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,11,4]]}},"alternative-id":["10.1128\/asmcr.00094-25"],"URL":"https:\/\/doi.org\/10.1128\/asmcr.00094-25","relation":{},"ISSN":["2996-2684"],"issn-type":[{"value":"2996-2684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,4]]},"assertion":[{"value":"2025-05-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00094-25"}}