Comparative activities of piperacillin and tazobactam against clinical isolates of Legionella spp

Collins, L A; Wennersten, Christine; Ferraro, Mary Jane; Moellering, R C; Eliopoulos, George M.

doi:10.1128/aac.38.1.144

Cited by 8 publications

(5 citation statements)

References 14 publications

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“…Our studies confirm the excellent extracellular activities of tazobactam, clavulanate, piperacillin, and ceftriaxone against legionellae, as has been reported previously (1,20,28,31,36,38,39). All p-lactamase inhibitors studied have been reported to be active against extracellular Legionella spp., including sulbactam and BL-P2013, in addition to those reported in the present study (18).…”

Section: Discussionsupporting

confidence: 72%

“…This has led to the evaluation of the activities of other P-lactamase inhibitors against L. pneumophila. Recently, Collins and colleagues (1) reported that tazobactam, with or without piperacillin, is active against extracellular Legionella species. We tested tazobactam alone and in combination with either ceftriaxone or piperacillin to confirm the findings of Collins and colleagues and to determine whether these antimicrobial agents were active against intracellular L. pneumophila.…”

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confidence: 99%

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In vitro extracellular and intracellular activities of clavulanic acid and those of piperacillin and ceftriaxone alone and in combination with tazobactam against clinical isolates of Legionella species

Edelstein

1994

Antimicrob Agents Chemother

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The activities of ceftriaxone, piperacillin, tazobactam, clavulanic acid, and combinations of ceftriaxone or piperacillin with tazobactam against 22 clinical Legionella isolates were measured by broth microdilution and macrodilution methods and in macrophages. The broth microdilution MICs that inhibited 90%o of strains tested were 2 and 1 ,ug/ml for ceftriaxone and tazobactam, respectively. Broth macrodilution MICs were 8 and 1 ,ug/ml, respectively, for the two LegioneUla pneumophila strains tested with piperacillin and were 0.25 and 0.5 ,ug/ml, respectively, for clavulanate. No significant intracellular anti-L. pneumophila activity was observed for ceftriaxone (32 ,ug/ml), piperacillin (32 ,ug/ml), tazobactam alone (16 ,Ig/ml), clavulanate alone (2 ,ig/ml), or tazobactam in combination with ceftriaxone (ceftriaxone/tazobactam at 32/4 and 16/16 ,ug/ml) or piperacillin (32/4 ,ig/ml). Erythromycin (1 ,ug/ml) was active against intracellular L. pneumophila in the same macrophage model of infection. It is very unlikely that tazobactam or clavulanate, alone or in combination with f-lactam antimicrobial agents, will be effective for the treatment of Legionnaires' disease in humans.Contrary to expectations, the ,-lactamase inhibitor clavulanic acid has been shown to be active against extracellular and intracellular Legionella pneumophila and in murine models of L. pneumophila infection (28, 33-36, 38, 39). This has led to the evaluation of the activities of other P-lactamase inhibitors against L. pneumophila. Recently, Collins and colleagues (1) reported that tazobactam, with or without piperacillin, is active against extracellular Legionella species. We tested tazobactam alone and in combination with either ceftriaxone or piperacillin to confirm the findings of Collins and colleagues and to determine whether these antimicrobial agents were active against intracellular L. pneumophila. The activity of clavulanic acid alone was also determined. We demonstrate that both tazobactam and clavulanic acid are active against extracellular, but not intracellular, L. pneumophila. MATERIALS AND METHODSBacteria and growth media. All legionellae studied were clinical isolates. These strains were identical to those used in prior studies and comprised 2 strains each of Legionella dumoffli, Legionella longbeachae, Legionella micdadei, 1 strain of Legionella bozemanii, and 15 strains of L. pneumophila (9,12

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Section: Discussionsupporting

confidence: 72%

mentioning

confidence: 99%

In vitro extracellular and intracellular activities of clavulanic acid and those of piperacillin and ceftriaxone alone and in combination with tazobactam against clinical isolates of Legionella species

Edelstein

1994

Antimicrob Agents Chemother

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“…Erythromycin, probably the most widely used drug for treatment of Legionella pneumonia (14,27), inhibited all strains at Յ0.25 and Յ0.5 g/ml with the small and the large inocula, respectively. Those data were comparable to erythromycin A MICs obtained previously in our laboratory (7).…”

supporting

confidence: 90%

“…(25,34,36). At the smaller inoculum, 90% of the legionellae tested were inhibited by a 4-g/ml concentration of each drug, a concentration equivalent to MICs (7). Nevertheless, doxycycline showed activity against L. pneumophila in intracellular monocyte experiments when added at concentrations of 0.4 g/ml (20).…”

mentioning

confidence: 95%

Susceptibilities of Legionella spp. to Newer Antimicrobials In Vitro

Schülin

Wennersten

Ferraro

et al. 1998

Antimicrob Agents Chemother

107

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The in vitro activities of 13 antimicrobial agents against 30 strains of Legionella spp. were determined. Rifapentine, rifampin, and clarithromycin were the most potent agents (MICs at which 90% of isolates are inhibited [MIC 90 s], <0.008 g/ml). The ketolide HMR 3647 and the fluoroquinolones levofloxacin and BAY 12-8039 (MIC 90 s, 0.03 to 0.06 g/ml) were more active than erythromycin A or roxithromycin. The MIC 90 s of dalfopristin-quinupristin and linezolid were 0.5 and 8 g/ml, respectively. Based on class characteristics and in vitro activities, several of these agents may have potential roles in the treatment of Legionella infections.

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“…The quantitative MIC was 0.016 g/ml. Our results showed a lower MIC than previous reports by Edelstein et al and Collins et al, which showed MICs between 0.12 and 1 g/ml and between 0.03 and 2 g/ml, respectively, reinforcing the effectiveness of these antibiotics against extracellular forms (4,5).…”

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confidence: 56%

Isolation on Chocolate Agar Culture of Legionella pneumophila Isolates from Subcutaneous Abscesses in an Immunocompromised Patient

et al. 2015

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Clin Infect Dis 16:51-53, 1993). Here we report the identification of Legionella pneumophila isolates, from subcutaneous abscesses in an immunocompromised patient, that grew in an unusual medium for Legionella bacteria. CASE REPORTA 72-year-old man presented with a 3-week history of painful erythematous lesions of the right foot. His medical history was marked by a rectal adenocarcinoma with lung metastasis managed by chemotherapy and radiotherapy and complicated by radiation-induced pulmonary disease. Three weeks before his admission, he was hospitalized for pneumonitis, which was treated empirically with a combination of piperacillin and tazobactam (Pip/Taz; 4/0.5 g given intravenously for 30 min every 8 h) for 15 days. His fever and respiratory signs resolved but were followed by the occurrence of the skin lesions that led to his hospitalization. On admission, clinical examination revealed no fever and stable hemodynamic parameters. Skin examination revealed two newly appearing erythematous plaques over the internal malleolus and the second and third metatarsophalangeal joints of the right foot, measuring approximately 30 mm in diameter each, in the absence of previous local trauma. Palpation of the lesions revealed fluctuation signs with tenderness. The rest of the clinical examination was normal, with neither pulmonary abnormalities nor cardiac murmur. His white blood cell count was 10,900 leukocytes/mm 3 with 80% neutrophils. His serum C-reactive protein level was increased to 60.3 mg/liter. Other routine laboratory blood tests were normal. A computed tomography (CT) scan of the right lower limb revealed two subcutaneous collections below the erythematous zones without joint effusion (Fig. 1). As fine-needle aspiration of the subcutaneous collections revealed frank pus, surgical drainage of the abscesses was performed before antibiotic therapy based on amoxicillin-clavulanate was started. The pus samples were processed according to standard operating procedures. Gram staining of tissue samples did not show any bacteria, and samples were inoculated into Columbia sheep blood agar (Oxoid), supplemented chocolate agar (bioMérieux), and thioglycolate broth (Oxoid) and incubated for 15 days at 37°C with 5% CO 2 . Additionally, brucella blood agar (BD) was inoculated and incubated for 15 days at 37°C under anaerobic conditions. The Columbia sheep blood agar, thioglycolate broth, and anaerobic cultures did not show growth after 3 weeks of incubation. On day 9, small, catalase-positive, oxidase-positive pinpoint colonies were noted only on the supplemented chocolate agar medium (Fig. 1). No identification was obtained by conventional phenotypic methods. Analysis of the 16S rRNA gene sequence by a previously described method (1) revealed 100% identity with Legionella pneumophila. A Legionella-specific PCR assay (with primers designed to amplify a 106-bp DNA fragment of the 16S rRNA gene specific to Legionella species) secondarily performed was positive, explaining the absence of growth on the other media. In consequ...

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Comparative activities of piperacillin and tazobactam against clinical isolates of Legionella spp

Cited by 8 publications

References 14 publications

In vitro extracellular and intracellular activities of clavulanic acid and those of piperacillin and ceftriaxone alone and in combination with tazobactam against clinical isolates of Legionella species

In vitro extracellular and intracellular activities of clavulanic acid and those of piperacillin and ceftriaxone alone and in combination with tazobactam against clinical isolates of Legionella species

Susceptibilities of Legionella spp. to Newer Antimicrobials In Vitro

Isolation on Chocolate Agar Culture of Legionella pneumophila Isolates from Subcutaneous Abscesses in an Immunocompromised Patient

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