Wang-Huei Sheng, Jann-Tay Wang, Shan-Chwen Chang
Department of Internal Medicine, National Taiwan University Hospital, Taipei, ROC
Proper and timely choice of the antibiotic therapy for the management of infection in hospitalized patients is an immense challenge to the clinician. A newly developed extended-spectrum fourth-generation cephalosporin cefepime, has been shown to have good activity against both gram-positive and gram-negative organisms. In order to further establish the efficacy and safety of cefepime in the treatment of adult hospitalized patients in Taiwan, we reviewed the medical records of all patients who received cefepime therapy for more than 72 h at the National Taiwan University Hospital during the period from January 1999 to April 1999. A total of 55 patients were treated with cefepime during this period. Thirty-two of them were males and 23 were females. Their ages ranged from 16 to 94 years old (average, 67). All had severe infections with a mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 18. More than half (56%) of the infections were nosocomial. The most common infections included pulmonary infection (49%), intra-abdominal infection (27%), skin and soft tissue infection (15%), febrile neutropenia (7%), and intravascular device infection (5%). All but one of the patients (98%) had pre-existing medical disease. Malignancy (49%) was the most common underlying illness. Pseudomonas aeruginosa (23 isolates) and Enterobacter cloacae (21) were the most common pathogens causing infections. Thirty-one (58%) of the patients were effectively treated with cefepime. Twenty of the patients died during the study period with most deaths attributable to persistent microbial infection and superinfection, especially Acinetobacter baumannii and fungal infection. Adverse effects developed in six patients, including eosinophilia (3 patients), leukopenia (2), skin rash (1), and drug related fever (1), but all were mild and transient. The results of this study show that cefepime is a safe and effective agent in the treatment of adult patients with severe infection in Taiwan.
J Microbiol Immunol Infect 2000;33:109-114.