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Cefepime

Cefepime is a fourth generation intravenous cephalosporin antibiotic developed in 1994. Cefepime has broad spectrum activity against Gram positive and Gram negative bacteria. It has good activity against Pseudomonas aeruginosa, Staphylococcus aureus, and multiple drug resistant Streptococcus pneumoniae. A particular strength is its activity against Enterobacteriaceae. more...

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Whereas other cephalosporins are degraded by many plasmid- and chromosome-mediated beta-lactamases, cefepime is stable and is a front line agent when infection with Enterobacteriaceae is known or suspected. Cefepime is commonly used to treat severe nosocomial pneumonia and neutropenic fever.

Cefepime is marketed under the trade names Maxipime, Maxcef, Cepimax, Cepimex, and Axepim.

Read more at Wikipedia.org


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Clinical and treatment patterns among 398 patients with ventilator-associated pneumonia: final results of the assessment of local antimicrobial resistance
From CHEST, 10/1/05 by Marin H. Kollef

PURPOSE: ALARM was a prospective, observational, cohort study designed to capture and analyze management and outcome variable patterns for ventilator-associated pneumonia (VAP).

METHODS: Investigators from 20 institutions within the United States identified 398 (60.8% male; mean age, 58.3 yrs) ICU patients with a diagnosis of VAP. Clinical, diagnostic, and treatment data were gathered on each patient for the duration of ICU stay. Escalation/de-escalation of therapy was defined as switching to or adding a drug class(es) with a broader/narrower spectrum, respectively, or additional/less coverage as defined by the following spectrum categories: carbapenem> cefepime> ureidopenicillin/monobactam> quinolone> other/none.

RESULTS: The mean duration of mechanical ventilation prior to VAP diagnosis was 7.3 + 6.9 days (range, 0-44 days). Tracheal aspirate cultures (58.3% of patients), bronchoalveolar lavage fluid cultures (33.7%), or both (1.8%) were used to identify major pathogens, which included methicillin-resistant Staphylococcus aureus (14.8%), Pseudomonas aeruginosa (14.3%), other Staphylococcus species (8.8%), Klebsiella pneumoniae (3.3%), Enterobacter (3.3%), E coli (3.0%), and Acinetobacter (2.0%). The most common initial treatment regimens consisted of (alone or with other agents): cefepime (30.4%), piperacillin/tazobactam (27.9%), and vancomycin (17.8%). Mean duration of therapy was 11.8 days. Patterns of antibiotic therapy changes for VAP are shown in Table 1. Escalation of therapy occurred in 14.8% of patients and de-escalation in 22.4%. Overall mortality was 25.1%. Comparative mortality was lower among patients whose therapies were de-escalated (16.9%) compared to both patients undergoing escalation (42.4%) and those for whom therapy was neither escalated nor de-escalated (31.6%). Mean change in CPIS score at 72 hours was significantly less among patients who died (-0.10) compared with survivors (-2.35) (p<.05).

CONCLUSION: This multicenter study confirms that VAP in the ICU setting is associated with unacceptably high mortality rates.

CLINICAL IMPLICATIONS: Choices regarding initial antibiotic regimens and subsequent escalation/de-escalation of therapy have significant implications for patient outcomes.

DISCLOSURE: Matin Kollef, Grant monies (from industry related sources), The ALARM Study has been funded by a grant from Elan Pharmaceuticals.

Marin H. Kollef MD * Kenneth V. Leeper MD Antonio Anzueto MD Lee E. Morrow MD Lisa Benz-Scott PhD Frank J. Rodino MS Michael S. Niederman MD Washington University School of Medicine, St. Louis, MO

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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