Abstract Introduction: AmpC β-lactamase-producing Enterobacteriaceae pose significant therapeutic challenges, with carbapenems traditionally considered first-line therapy. However, antimicrobial stewardship concerns necessitate evaluation of alternative treatment strategies. Aim To compare clinical outcomes between non-carbapenem and carbapenem therapy for serious AmpC-producing infections. Method We conducted a retrospective cohort study at King Faisal Specialist Hospital absolute risk difference − 2.4%, 95% CI: -12.8% to 8.0%; p = 0.708). Similarly, 90-day mortality favored non-carbapenem therapy (14.0% vs 19.1%; p = 0.429). Clinical cure rates were higher with non-carbapenem therapy (71.9% vs 64.7%; p = 0.350). Among ICU patients, mortality was lower with non-carbapenem therapy (45.5% vs 52.4%; p = 0.710). Treatment escalation was less frequent in the non-carbapenem group (24.6% vs 29.4%; p = 0.550). After multivariable adjustment, non-carbapenem therapy remained associated with lower mortality odds (adjusted OR: 0.73, 95% CI: 0.24–2.21; p = 0.578). Conclusion Non-carbapenem therapy demonstrated comparable clinical effectiveness to carbapenems for serious AmpC β-lactamase-producing Enterobacteriaceae infections, with numerically favorable outcomes. These findings support non-carbapenem agents as viable alternatives, potentially enhancing antimicrobial stewardship efforts while preserving carbapenems for resistant infections.
Alhazmi et al. (Fri,) studied this question.
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