From the Guidelines
No, cefepime is not recommended for the treatment of infections caused by third-generation cephalosporin-resistant Enterobacterales (3GCephRE), including Enterobacter species, due to concerns about resistance and limited efficacy. According to the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1, cefepime is not suggested for use in 3GCephRE infections, with a conditional recommendation against its use based on very low-level evidence. The guidelines recommend carbapenems, such as imipenem or meropenem, as targeted therapy for patients with bloodstream infections and severe infections due to 3GCephRE 1.
- Key points to consider when treating Enterobacter infections include:
- Antimicrobial susceptibility testing should be performed whenever possible to guide antibiotic selection
- Carbapenems are generally recommended for severe infections caused by 3GCephRE, including Enterobacter species
- Alternative antibiotics, such as piperacillin-tazobactam, amoxicillin/clavulanic acid, or quinolones, may be considered for non-severe infections, but their use should be guided by susceptibility testing and antibiotic stewardship principles 1
- Cefepime's effectiveness against Enterobacter species can be compromised by the production of extended-spectrum beta-lactamases or carbapenemases, highlighting the need for careful antibiotic selection and susceptibility testing 1
From the FDA Drug Label
Cefepime has been shown to be active against most isolates of the following bacteria, both in vitro and in clinical infections [see Indications and Usage (1)]: Gram-negative bacteria Enterobacter spp Escherichia coli Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa
- Cefepime coverage: Cefepime covers Enterobacter species.
- Key points:
- Cefepime is active against Enterobacter spp.
- It is a bactericidal agent that acts by inhibition of bacterial cell wall synthesis.
- The efficacy of cefepime in treating clinical infections due to Enterobacter species has been established in adequate and well-controlled clinical trials 2
From the Research
Cefepime Coverage of Enterobacter
- Cefepime is a wide-spectrum β-lactam antibiotic that has been used to treat serious bacterial infections, including those caused by Enterobacter species 3.
- Studies have shown that cefepime is effective against Enterobacter species, including those with AmpC beta-lactamase production 4, 5, 6, 7.
- Cefepime has been compared to carbapenems in the treatment of Enterobacter species bacteremia, and the results suggest that cefepime is a viable alternative to carbapenems in certain cases 4, 5, 7.
Efficacy of Cefepime Against Enterobacter
- A study published in 2021 found that cefepime/zidebactam and cefepime/taniborbactam have activity against MBL-producing Enterobacterales and Pseudomonas aeruginosa, in vitro and in animal studies 3.
- Another study published in 2014 found that cefepime had a similar efficacy to carbapenems in the treatment of Enterobacter species bacteremia 4.
- A 2023 study found that high-dose cefepime was not associated with an increased risk of 30-day mortality compared to carbapenem therapy in patients with bacteremia caused by Enterobacterales with moderate to high risk of clinically significant AmpC production 7.
Clinical Use of Cefepime Against Enterobacter
- Cefepime can be used as a carbapenem-sparing agent in the treatment of Enterobacter species infections, particularly in clinically stable patients without initial renal impairment or increased susceptibility to neurological adverse events 5.
- The use of cefepime should be considered in cases where the minimum inhibitory concentration (MIC) is ≤2 µg/mL, and the patient has a moderate to high risk of clinically significant AmpC production 7.
- Cefepime/enmetazobactam and cefepime/taniborbactam are potential carbapenem-sparing agents with activity against ESBLs and are currently in clinical development 3.