302. Evaluation of Cefepime 1 Gram every 6 hours for Treatment of Gram-Negative Bacteremia
Session: Poster Abstract Session: Antimicrobial Therapy: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • 302_AndrewDeRyke.pdf (417.1 kB)
  • Background:  

    Cefepime (FEP) dosing of 1 gram (g) IV every 6 hours (h) is used commonly at our institution to maximize the free time above the MIC and is a cost-effective alternative to 2g IV every 8h. We report the outcomes of patients treated at our large community-teaching hospital using this novel regimen.

    Methods: 

    Inpatients at Orlando Health from 2008 to 2010 who received FEP for ≥ 72h for Gram-negative bacteremia due to a susceptible (FEP MIC ≤  8 µg/mL) microorganism were retrospectively evaluated. Patients with concomitant Gram-positive bacteremia or fungemia were excluded. Clinical success, mortality, and infection-related length of stay (IR-LOS) were compared based on novel (1g every 6h) v. standard (1g every 8h, 2g every 12h, or 2g every 8h) dosing.

    Results: 

    89 patients were identified, 21 and 68 in the novel and standard dosing groups, respectively. Baseline characteristics were similar between groups; however, more patients receiving novel dosing were in the ICU (67% v. 41%, p = 0.04). The most common organisms isolated were P. aeruginosa (27%), E. coli (22%), E. cloacae (14%), and K. pneumoniae (11%). FEP MICs (µg/mL) were ≤ 1 (76%), 2 (14%), 4 (7%), and 8 (6%). Comparing novel to standard dosing, no differences in time (hours) to first antibiotic dose, (8.9 [4.9-13.9] v. 6.0 [0.6-15], p = 0.3) or total days of antibiotic therapy (11.8 [8-13.7] v. 12.1 [6.9-14.3], p = 0.8) were observed. Clinical success (81% v. 82%, p = 1), mortality (5% v. 10%, p = 0.7), and IR-LOS (10.5 [8.8-14.1] v. 10.6 [7.0-15.6] days, p = 0.7) were also similar. Subgroup analysis of novel dosing compared to 2g IV every 8h (n = 24) showed no differences in clinical success (81% v. 88%, p = 0.7), mortality (4.8% v. 4.2%, p = 1), or IR-LOS (10.5 [8.8-14.1] v. 10.9 [7.1-15.7] days, p = 0.9).

    Conclusion: 

    FEP 1g IV every 6h demonstrated similar efficacy to standard doses and represents a cost-effective treatment strategy for bacteremic patients compared to 2g IV every 8h. 


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Matthew R. Helgeson, Pharm.D.1, Deba S. Rihani, Pharm.D.1, Robert A. Waite, Pharm.D.1, Mark R. Wallace, MD2 and C. Andrew DeRyke, Pharm.D.1,2, (1)Pharmacy, Orlando Health, Orlando, FL, (2)Infectious Diseases, Orlando Health, Orlando, FL

    Disclosures:

    M. R. Helgeson, None

    D. S. Rihani, None

    R. A. Waite, None

    M. R. Wallace, None

    C. A. DeRyke, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.