Cefepime for Complicated Skin and Soft Tissue Infections

Rationale for Treatment

• The patient presents with a serious skin and soft tissue infection (SSTI) with evidence of systemic involvement, which requires broad-spectrum antibiotic coverage, and cefepime has excellent activity against gram-negative pathogens, including Pseudomonas aeruginosa 1
• The Infectious Diseases Society of America (IDSA) guidelines recommend antipseudomonal antibiotics such as cefepime for complicated skin and soft tissue infections, particularly in immunocompromised hosts or when gram-negative pathogens are suspected 1, 2

Special Considerations for This Patient

• The patient's history of breast cancer with recent surgical intervention places her at higher risk for complicated infection, and the presence of tissue expanders complicates treatment and necessitates effective antimicrobial therapy 1, 3

Duration of Therapy

• IDSA guidelines recommend 7-14 days of therapy for most bacterial skin and soft tissue infections, with duration individualized based on clinical response 4

Potential Pitfalls and Considerations

• If MRSA is suspected as a co-pathogen, cefepime alone would not provide adequate coverage, and addition of an anti-MRSA agent might be necessary 3
• If clinical improvement is not observed within 48-72 hours, reassessment of therapy and consideration of surgical intervention may be necessary 5