Ventilator-Associated Pneumonia Due to ESBL-Producing Escherichia coli Successfully Treated with Cefepime/Enmetazobactam: A European Case Report

Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales represent a growing cause of ventilator- associated pneumonia (VAP) in critically ill patients. Although carbapenems remain the standard treatment, carbapenem-sparing strategies are increasingly needed to limit the emergence of carbapenem resistance. Cefepime/enmetazobactam (FEP/META) is a novel β-lactam/β-lactamase inhibitor combination with demonstrated activity against ESBL-producing organisms and favorable intrapulmonary pharmacokinetic properties. We present one of the first reported European cases of VAP due to CTX-M-producing Escherichia coli successfully treated with cefepime/enmetazobactam in a 72-year-old patient admitted to the intensive care unit for traumatic spinal cord injury. The isolate was resistant to third-generation cephalosporins and cefepime but remained susceptible to carbapenems and FEP/META (minimum inhibitory concentration [MIC] 0.06 mg/L). Targeted treatment with FEP/META (2.5 g every 8 h intravenously) was administered for 7 days. Rapid clinical and microbiological improvement was observed, with resolution of fever, decline in inflammatory biomarkers, and improvement in oxygenation parameters. No relapse or adverse events occurred. This case supports the potential role of FEP/META as a carbapenem-sparing option for ESBL-related VAP and highlights the importance of pharmacokinetic/pharmacodynamic considerations in optimizing antimicrobial stewardship strategies. Ventilator-associated pneumonia (VAP) is a serious lung infection that occurs in patients receiving mechanical ventilation in the intensive care unit. Some bacteria causing ventilator-associated pneumonia produce enzymes called extended-spectrum β-lactamases (ESBLs), which make them resistant to many commonly used antibiotics. Carbapenems are often used to treat these infections, but their widespread use may promote the development of further resistance. Cefepime/enmetazobactam is a new antibiotic combination designed to treat infections caused by ESBL-producing bacteria. We describe the case of a 72-year-old critically ill patient who developed ventilator-associated pneumonia caused by ESBL-producing Escherichia coli. The infection was successfully treated with cefepime/enmetazobactam without the need for carbapenem therapy. The patient improved rapidly and experienced no recurrence of infection. This report suggests that cefepime/enmetazobactam may represent an effective carbapenem-sparing treatment option for certain severe lung infections, although further clinical studies are needed.