Efficacy of Cefepime/Enmetazobactam (Cipenmet) in Piperacillin‑Tazobactam Resistant Urinary Tract Infections: A Cross‑Sectional Study

Abstract

Introduction: Urinary tract infections (UTIs) are among the most common bacterial infections, with rising resistance to conventional antimicrobials such as piperacillin tazobactam. Carbapenem resistance further complicates management, necessitating evaluation of novel agents.

Aim: To assess the efficacy of cefepime/enmetazobactam (Cipenmet) in piperacillin tazobactam resistant UTIs and estimate the prevalence of resistance among Enterobacterales isolates.

Methods: A cross sectional study was conducted on 600 urine specimens, of which 288 yielded Enterobacterales. Among these, 153 isolates were resistant to piperacillin tazobactam; 65 isolates resistant to both piperacillin tazobactam and ceftriaxone were included. Antimicrobial susceptibility was tested using CLSI guidelines, including Cipenmet and carbapenems.

Results: Klebsiella pneumoniae (48%) and Escherichia coli (45%) were the predominant isolates. Catheterization was present in 80% of cases. Carbapenem resistance was observed in 54% of isolates, while Cipenmet resistance was higher at 66%. A strong correlation was noted between Cipenmet and carbapenem resistance (χ² = 38.79, p < 0.001).

Conclusion: Cipenmet demonstrated limited efficacy in this cohort, with resistance strongly associated with carbapenem resistance. These findings highlight the urgent need for continued surveillance and exploration of alternative therapeutic strategies.