ObjectiveThis systematic review and meta-analysis evaluated the clinical efficacy and safety of carbapenems versus non-carbapenem antibiotics in adult hospitalized patients with AmpCproducing Enterobacterales infections across various infection sites. MethodsA comprehensive search of PubMed, Embase, and Cochrane Library databases was conducted for observational studies and randomized controlled trials comparing carbapenems with alternative agents.Primary outcomes included 30-day all-cause mortality, microbiological failure, infection recurrence, and adverse drug reactions (ADRs). ResultsSeventeen studies met the inclusion criteria.There was no significant difference in 30-day mortality (OR = 1.29; 95% CI: 0.91-1.82;p = 0.16) or infection recurrence (OR = 0.98; 95% CI: 0.32-2.97;p = 0.97) between carbapenems and non-carbapenems.Microbiological failure rates were also comparable.However, carbapenems were associated with a higher incidence of ADRs (OR = 4.32; 95% CI: 1.73-10.79;p = 0.03).Clinical success trended in favor of non-carbapenem agents, though the difference did not reach statistical significance (OR = 0.56, 95% CI: 0.29-1.08;p = 0.08). ConclusionWhile carbapenems remain effective for AmpC-producing infections, non-carbapenem alternatives offer comparable outcomes with fewer adverse events.These findings support IDSA guidance recommending agents such as cefepime when the MIC is 2 g/mL and highlight the need for individualized, susceptibility-guided therapy.
Saleh et al. (2026) studied this question.