{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T12:24:59Z","timestamp":1774355099850,"version":"3.50.1"},"reference-count":41,"publisher":"Scientific Scholar","content-domain":{"domain":["ijmr.org.in"],"crossmark-restriction":true},"short-container-title":["Indian J Med Res"],"abstract":"<jats:p>\n                    Complicated urinary tract infections (UTIs) caused by extended-spectrum \u03b2-lactamase (\n                    <jats:italic>ESBL<\/jats:italic>\n                    )- and AmpC \u03b2-lactamase-producing Enterobacterales are increasing in India, driving carbapenem use. Cefepime\u2013enmetazobactam (CPM\u2013EMT), a \u03b2-lactamase inhibitor active against class A\n                    <jats:italic>ESBLs<\/jats:italic>\n                    and with partial activity against\n                    <jats:italic>AmpC<\/jats:italic>\n                    , but is inactive against metallo-\u03b2-lactamases (MBLs). We conducted a narrative review (2018\u20132025) of PubMed\/MEDLINE, ClinicalTrials.gov, and regulatory sources, prioritising randomised trials, surveillance, pharmacokinetic\/pharmacodynamic studies, and antimicrobial stewardship programme (AMSP) guidance, with emphasis on Indian resistance trends. In the Phase 3 ALLIUM trial, CPM\u2013EMT achieved superior overall treatment success versus piperacillin\u2013tazobactam in patients with complicated UTI and acute pyelonephritis, including\n                    <jats:italic>ESBL<\/jats:italic>\n                    subgroups.\n                    <jats:italic>In vitro<\/jats:italic>\n                    , CPM\u2013EMT restores cefepime activity against\n                    <jats:italic>ESBL<\/jats:italic>\n                    -producing Enterobacterales; activity against\n                    <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                    is variable and largely cefepime-driven. Safety is similar to cefepime; the risk of neurotoxicity increases with renal impairment, supporting renal dose adjustment and prolonged infusion in augmented renal clearance. CPM\u2013EMT is approved in the United States, European Union, and India. CPM\u2013EMT is a carbapenem-sparing option for\n                    <jats:italic>ESBL<\/jats:italic>\n                    \/\n                    <jats:italic>AmpC<\/jats:italic>\n                    complicated UTI when MBL risk is low or excluded by rapid carbapenemase testing and local epidemiology. It is not appropriate for empiric use in haemodynamically unstable ICU patients or where carbapenemase prevalence (\n                    <jats:italic>e.g<\/jats:italic>\n                    .,\n                    <jats:italic>NDM<\/jats:italic>\n                    -\u03b2-lactamase,\n                    <jats:italic>OXA<\/jats:italic>\n                    -48-like,\n                    <jats:italic>KPC<\/jats:italic>\n                    ) is high; mechanism-directed alternatives (\n                    <jats:italic>e.g.,<\/jats:italic>\n                    ceftazidime\u2013avibactam with or without aztreonam, cefiderocol) are preferred. Evidence gaps include paediatric dosing\/safety, Indian real-world comparative outcomes, Pseudomonas-specific efficacy, and cost-effectiveness. Implementation in India should integrate rapid diagnostics, local antibiograms, and optimised dosing within AMSP pathways to preserve carbapenems without compromising outcomes.\n                  <\/jats:p>","DOI":"10.25259\/ijmr_2073_2025","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:00:43Z","timestamp":1773925243000},"page":"183-193","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cefepime-enmetazobactam for complicated urinary tract infections: Redefining ESBL therapy"],"prefix":"10.25259","volume":"163","author":[{"given":"Prashant","family":"Chandra","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishva Vidyapeetham, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"10.25259\/IJMR_2073_2025\/ref-1","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1186\/s41043-025-00950-y","article-title":"Global, regional, and national lifetime probabilities of urinary tract infections and interstitial nephritis from 1990 to 2021","volume":"44","author":"Li","year":"2025","journal-title":"J Health Popul Nutr."},{"key":"10.25259\/IJMR_2073_2025\/ref-2","article-title":"P-1563 assessing the global economic burden of complicated urinary tract infections: A systematic literature review","volume":"12","author":"Broughton","year":"2025","journal-title":"Eur J Health Econ."},{"key":"10.25259\/IJMR_2073_2025\/ref-3","doi-asserted-by":"publisher","first-page":"e53828","DOI":"10.2196\/53828","article-title":"Economic burden of community-acquired antibiotic-resistant urinary tract infections: Systematic review and meta-analysis","volume":"10","author":"Zhu","year":"2024","journal-title":"JMIR Public Health Surveill."},{"key":"10.25259\/IJMR_2073_2025\/ref-4","doi-asserted-by":"publisher","first-page":"223","DOI":"10.4103\/cjhr.cjhr_105_22","article-title":"Cost of care and impact on quality of life of upper urinary tract infections in south India with a focus on diabetics and extended-spectrum beta-lactam producing organisms","volume":"9","author":"Daniel","year":"2022","journal-title":"CHRISMED J Health Res."},{"key":"10.25259\/IJMR_2073_2025\/ref-6","doi-asserted-by":"publisher","first-page":"164","DOI":"10.4103\/ijmr.IJMR_226_18","article-title":"Establishing antimicrobial resistance surveillance research network in India: Journey so far","volume":"149","author":"Walia","year":"2019","journal-title":"Indian J Med Res."},{"key":"10.25259\/IJMR_2073_2025\/ref-7","volume-title":"Complicated urinary tract infections. 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