Year: 2026 | Month: February | Volume: 16 | Issue: 2 | Pages: 313-318
DOI: https://doi.org/10.52403/ijhsr.20260234
Cefepime Enmetazobactam: A Carbapenem Sparing Strategy Against ESBL Producing Enterobacterales
Stefy Baby1, Deepa S2, Rajesh S3, Amrutha Kumari B4
1Post Graduate, Department of Microbiology, Mysore Medical College Hospital & Research Institute, Mysore,
2Associate Professor, Department of Microbiology, Mysore Medical College Hospital & Research Institute, Mysore
3Post Graduate, Department of Microbiology, Mysore Medical College Hospital & Research Institute, Mysore
4Professor & Head of the Department, Department of Microbiology, Mysore Medical College Hospital & Research Institute, Mysore
Corresponding Author: Stefy Baby
ABSTRACT
Background & Objectives: The rise of antimicrobial resistance, particularly among Gram-negative pathogens producing extended-spectrum β-lactamases (ESBLs), is a major global concern. Carbapenems remain the mainstay of therapy but their overuse has led to the emergence of carbapenemases, emphasizing the need for carbapenem-sparing alternatives. Cefepime combined with Enmetazobactam, a novel β-lactam/β-lactamase inhibitor combination, has shown promising activity against ESBL-producing Enterobacterales. The present study aimed to evaluate in-vitro susceptibility profile of Cefepime-Enmetazobactam compared to other commonly used antimicrobials.
Methods: This prospective study was carried out in the Department of Microbiology over a six-month period (April–September 2025). A total of 192 ESBL-producing Enterobacterales isolates obtained from blood, urine and respiratory samples of patients aged ≥18 years were included. Susceptibility testing of Cefepime–enmetazobactam and other antibiotics were assessed by Kirby Bauer disk diffusion, and results were interpreted using EUCAST 2024 guidelines.
Results: Among the 192 ESBL-producing Enterobacterales isolates, E.coli (48%) was the most common pathogen, followed by Klebsiella spp.(45%) and Enterobacter spp.(6%).Cefepime–enmetazobactam showed an overall susceptibility rate of 91.7%,with higher activity against E. coli (94.6%),Klebsiella spp.(88.5%) and Enterobacter spp.(91.7%).When compared with other antibiotics, Cefepime–enmetazobactam demonstrated superior efficacy over Meropenem(47.9%),Imipenem(43.2%)and Piperacillin–tazobactam(20.8%).Higher susceptibility to Cefepime–enmetazobactam was observed in urinary tract infections(95.5%) and bloodstream infections(95%) compared to lower respiratory tract infections(77.5%).
Conclusion: Cefepime-Enmetazobactam exhibited superior in-vitro activity against ESBL-producing Enterobacterales compared to most β-lactams and fluoroquinolones, and demonstrated comparable efficacy to carbapenems. These findings support its potential role as a carbapenem-sparing therapeutic option, especially in urinary tract infections. Continuous surveillance and clinical outcome studies are warranted to establish its role in antimicrobial stewardship programs.
Key words: ESBL-producing Enterobacterales, Cefepime–Enmetazobactam, β-lactamase inhibitors, Carbapenem-sparing therapy, antimicrobial susceptibility testing, Kirby–Bauer disk diffusion, EUCAST breakpoints