Abstract / Summary
Cefmetazole and flomoxef are alternative therapies for extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) bacteremia in Asia; however, their comparative efficacy remains unclear. We evaluated their efficacy versus carbapenems in adults with ESBL-PE bacteremia. We conducted a systematic review and meta-analysis of targeted therapy for ESBL-PE bacteremia in adults. Primary outcomes were 14-day and 30-day mortality. Odds ratios (ORs) were pooled using fixed- and random-effects models. Ten studies (975 patients) were included. Fourteen-day mortality (5 studies) was significantly higher in the cefmetazole/flomoxef group than in the carbapenem group (fixed-effect OR: 2.32; 95% CI: 1.24-4.35; I2 = 30%), primarily driven by flomoxef in high-risk populations. Conversely, 30-day mortality (6 studies), largely reflecting cefmetazole use, showed no significant difference between groups (fixed-effect OR: 1.12; 95% CI: 0.71-1.75; I2 = 69%). Subgroup analyses revealed flomoxef was associated with increased 14-day mortality (OR: 2.50; 95% CI: 1.32-4.73), whereas cefmetazole was associated with decreased 30-day mortality (OR: 0.34; 95% CI: 0.14-0.84) versus carbapenems. However, cefmetazole results may have been influenced by treatment-selection bias, including lower baseline severity and more controllable infection foci. The clinical impacts of cefmetazole and flomoxef varied by agent and clinical context. Flomoxef was associated with increased 14-day mortality in high-risk populations, whereas overall 30-day mortality with cefmetazole did not differ significantly from carbapenems after accounting for clinical heterogeneity. Given this variability, a unified effect cannot be determined. Randomized controlled trials stratified by agent and disease severity are needed to evaluate their potential as carbapenem-sparing therapies.
Primary Source
Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
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