Cefepime versus extended spectrum β-lactamase-producing Enterobacteriaceae

• Published in: The Brazilian journal of infectious diseases Vol. 15; no. 2; pp. 167 - 169
• Main Authors: Nogueira, Keite da Silva, Daur, Alessandra Vale, Reason, Iara Taborda de Messias, Gales, Ana Cristina, Costa, Libera Maria Dalla
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier Editora Ltda 01-03-2011; Contexto; Elsevier
• Subjects: Anti-Bacterial Agents - pharmacology; Beta lactamases; beta-Lactamases - biosynthesis; Cephaloridine; cephalosporin resistance; Cephalosporins; Cephalosporins - pharmacology; enterobacteriaceae; Enterobacteriaceae - classification; Enterobacteriaceae - drug effects; Enterobacteriaceae - enzymology; Humans; Microbial Sensitivity Tests - methods; Moxalactam; Brazil; enterobacteriaceae; beta-lactamases; cephalosporin resistance
• ISSN: 1413-8670; 1678-4391
• DOI: 10.1016/S1413-8670(11)70165-9

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.