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.