Journal Information
Vol. 15. Issue 2.
Pages 167-169 (March - April 2011)
Share
Share
Download PDF
More article options
Vol. 15. Issue 2.
Pages 167-169 (March - April 2011)
Brief Communication
Open Access
Cefepime versus extended spectrum β-lactamase-producing Enterobacteriaceae
Visits
3064
Keite da Silva Nogueira1,
Corresponding author
keitenogueira@hotmail.com

Correspondence to: Rua Comendador Macedo, 275. Ap.63. 80060-030 Centro, Curitiba, Paraná, Brazil.
, Alessandra Vale Daur1, Iara Taborda de Messias Reason2, Ana Cristina Gales3, Libera Maria Dalla Costa2
1 Pharmacist, Hospital de Clínicas, Universidade Federal do Paraná - UFPR, Curitiba, Brazil
2 Researcher, Hospital de Clínicas, UFPR, Curitiba, Brazil
3 Laboratório Alerta, Universidade Federal de São Paulo, São Paulo, Brazil
This item has received

Under a Creative Commons license
Article information
Abstract
Bibliography
Download PDF
Statistics
Abstract

The objective of this study was to evaluate the susceptibility to cefepime of a large group of ESBL-producing enterobacteria recently isolated in a Brazilian teaching hospital. The study included 280 strains of ESBL-producing enterobacteria, isolated between 2005 and 2008. The presence of the genes blaCTX-M, blaTEM and blaSHV was determined by PCR and confirmed by nucleotide sequencing. Susceptibility testing for cefepime was performed by disc-diffusion, agar dilution method and E-test®. Among the isolates, 34 (12.1%) presented a cefepime inhibition zone ≥ 21 and MIC ≤ 8mg/L by agar dilution and E-strip methods. The use of cefepime for the treatment of infections caused by ESBL-producing bacteria has been controversial. Some studies of PD/PK show the probability of achieving the required PD parameters for cefepime, when the MICs were <8mg/L, whereas others have reported therapeutic failure with the same MIC. Additional data is essential to come to terms about the report and treatment with cefepime in ESBL-producing organisms especially when these microorganisms are isolated from sterile sites and from critically ill patients.

Keywords:
enterobacteriaceae
beta-lactamases
cephalosporin resistance
Full text is only aviable in PDF
References
[1.]
Clinical Laboratory and Standard Institute.
Performance Standards for Antimicrobial Susceptibility Testing; Twentieth Informational Supplement M100-S20.
CLSI, (2010),
[2.]
European Committee on Antimicrobial Susceptibility Testing.
Breakpoints and expert rules for 3rd and 4th generation cephalosporins and Enterobacteriaceae with and without beta-lactam resistance organisms.
EUCAST, (2009),
[3.]
A. Endimiani, F. Perez, R.A. Bonomo.
Cefepime: a reappraisal in an era of increasing antimicrobial resistance.
Expert Rev Anti Infect Ther, 6 (2008), pp. 805-824
[4.]
D. Maglio, C. Ong, M.A. Banevicius, et al.
Determination of the in vivo pharmacodynamic profile of cefepime against extended-spectrum-beta-lactamase-producing Escherichia coli at various inocula.
Antimicrob Agents Chemother, 48 (2004), pp. 1941-1947
[5.]
S.Y. Lee, J.L. Kuti, D.P. Nicolau.
Cefepime pharmacodynamics in patients with extended spectrum beta-lactamase (ESBL) and non-ESBL infections.
J Infect, 54 (2007), pp. 463-468
[6.]
Clinical Laboratory and Standard Institute.
Performance Standards for Antimicrobial Disk Susceptibility Tests; approved Standard - Tenth Edition document M02-A10.
CLSI, (2009),
[7.]
D.J. Payne, C.J. Thomsom.
Molecular approaches for the detection and Identification of beta-lactamases.
Molecular Bacteriology: Protocols and Clinical Applications,
[8.]
H.S. Sader, T.R. Fritsche, R.N. Jones.
Potency and spectrum trends for cefepime tested against 65746 clinical bacterial isolates collected in North American medical centers: results from the SENTRY Antimicrobial Surveillance Program (1998–2003).
Diagn Microbiol Infect Dis, 52 (2005), pp. 265-273
[9.]
C.H. Liao, W.H. Sheng, J.T. Wang, et al.
In vitro activities of 16 antimicrobial agents against clinical isolates of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in two regional hospitals in Taiwan.
J Microbiol Immunol Infect, 39 (2006), pp. 59-66
[10.]
S. Kotapati, J.L. Kuti, C.H. Nightingale, D.P. Nicolau.
Clinical implications of extended spectrum beta-lactamase (ESBL) producing Klebsiella species and Escherichia coli on cefepime effectiveness.
J Infect, 51 (2005), pp. 211-217
[11.]
D. Yahav, M. Paul, A. Fraser, N. Sarid, L. Leibovici.
Efficacy and safety of cefepime: a systematic review and meta-analysis.
Lancet Infect Dis, 7 (2007), pp. 338-348
Copyright © 2011. Elsevier Editora Ltda.. All rights reserved
Download PDF
The Brazilian Journal of Infectious Diseases
Article options
Tools