How to optimize administration of cefoxitin for the treatment of extended spectrum producing Enterobacteriaceae-related infection?

Abstract

Pharmacological and clinical data regarding cefoxitin for the treatment of ESBL-producing Enterobacteriaceae-related infections are limited. We performed a multicentric prospective cohort study to evaluate continuous/prolonged, or intermittent infusion of cefoxitin. We assessed the plasma concentration as a function of the duration of infusion and then performed a simulation of the percentage of patients who would reach the PK/PD targets, set at 100% ƒT> MIC or 100% ƒT>4 MIC. Eighty-one patients were included. All patients were treated with 6 gr./day. MICs to cefoxitin ranged from 0.5 to 64 mg/L. Sixteen (19.7%) patients were infected with strains with cefoxitin MICs ≥ 8 mg/L. In all patients infected with strains with MICs ≤ 6 mg/L, PK/PD objectives (100% ƒT> MIC) were achieved with prolonged or continuous infusion. In contrast, when MICs were 8 mg/L only, continuous infusion was sufficient to achieve the PK/PD objectives (100% ƒT> MIC). Extended infusion of cefoxitin is necessary for the treatment of non-UTI ESBL-related infections.

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Abbreviations

BSI:

bloodstream infection

CI:

continuous infusion

ESBL:

extended-spectrum beta-lactamase

IB:

intermittent bolus

MIC:

minimum inhibitory concentration

PD:

pharmacodynamic

PI:

prolonged infusion

PK:

pharmacokinetic

PTA:

probability of target attainment

UTI:

urinary tract infusion

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Correspondence to Benoît Pilmis.

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Pilmis, B., Mizrahi, A., Mory, C. et al. How to optimize administration of cefoxitin for the treatment of extended spectrum producing Enterobacteriaceae-related infection?. Eur J Clin Microbiol Infect Dis (2021). https://doi.org/10.1007/s10096-021-04165-x

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Keywords

  • Cefoxitin
  • ESBL
  • PK/PD