In vitro evaluation of cefepime and other broad-spectrum β-lactams against bacteria from Indonesian medical centers

• Published in: Diagnostic microbiology and infectious disease Vol. 35; no. 4; pp. 285 - 290
• Main Authors: Lewis, M.Todd, Biedenbach, Douglas J., Jones, Ronald N.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-12-1999; Elsevier
• Subjects: Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiseptics; Bacteriology; Biological and medical sciences; Epidemiology; Fundamental and applied biological sciences. Psychology; Medical sciences; Microbiology; Pharmacology. Drug treatments; Tropical medicine; Asia; Indonesia; Cephalosporin derivatives; Antibiotic; Sensitivity resistance; Cefepime; β-Lactams; Minimum inhibitory concentration; Activity spectrum; Antibacterial agent; Epidemiology; In vitro; Clinical isolate; Biological activity
• ISSN: 0732-8893; 1879-0070
• DOI: 10.1016/S0732-8893(99)00099-1

The in vitro activity of cefepime and six other broad-spectrum β-lactams (cefpirome, ceftazidime, ceftriaxone, imipenem, piperacillin/tazobactam (4 μg/mL fixed concentration), and oxacillin was evaluated against 191 isolates of clinical bacteria from Indonesia. Susceptibility testing was performed using Etest (AB BIODISK, Solna, Sweden) methodology. Isolates from 10 species groups were selected for analysis:
Escherichia coli,
Klebsiella spp.,
Enterobacter spp., indole-positive
Proteae,
Serratia spp.,
Acinetobacter spp.,
Pseudomonas aeruginosa, and oxacillin-susceptible staphylococci. The overall rank order of spectrum of activity was (% resistant): imipenem (2.2%) > cefepime (7.3%) > piperacillin/tazobactam > cefpirome > ceftazidime > ceftriaxone (16.2%). The “fourth-generation” cephalosporins, cefepime and cefpirome, displayed greater activity compared with the “third-generation” cephalosporins, ceftazidime, and ceftriaxone, against the 60
E. coli and
Klebsiella spp. (30 each) isolates. Phenotypic extended spectrum β-lactamase occurrence rates among the
E. coli and
Klebsiella spp. were 23.3 and 33.3%, respectively. Imipenem, cefepime, and cefpirome inhibited 95.7% of the 46 isolates of inducible Amp C cephalosporinase producing Enterobacteriaceae. The majority of the resistance observed to imipenem and cefepime among tested Indoneisian strains was attributable to the nonfermentative Gram-negative bacilli,
P. aeruginosa and
Acinetobacter spp. These results indicate the presence of β-lactam resistance in Indonesia and the need for continued antimicrobial surveillance in this nation and region of the world, preferably using accurate quantitative methods.