Impact of Cefepime Susceptible-Dose-Dependent MIC for Enterobacteriaceae on Reporting and Prescribing

Abstract

The CLSI cefepime breakpoints were revised to include a susceptible-dose-dependent (SDD) category for Enterobacteriaceae, with the intention that higher cefepime doses be used for these isolates. In this study, 1.6% of Enterobacteriaceae isolates were reported as SDD, with Escherichia coli the most common SDD organism. Cefepime was prescribed in three cases (4.8%); the majority of SDD isolates were treated with a carbapenem. Enterobacteriaceae with cefepime SDD MICs were not commonly treated with cefepime at our institution.

Understanding and Application of Daptomycin-Susceptible Dose-Dependent Category for Enterococcus: A Mixed-Methods Study

“…This variability in susceptibilities, coupled with provider unfamiliarity surrounding the SDD interpretive criteria or a preference for use of an antimicrobial reported as susceptible over SDD (eg, linezolid), may have impacted the agent selected for definitive therapy. A similar finding was seen in a small retrospective analysis of cefepime SDD Enterobacterales isolates wherein most infections were treated with a carbapenem instead of cefepime [ 8 ]. However, in that study all cefepime SDD isolates were dosed in accordance with CLSI guidance, whereas daptomycin was not always dosed to SDD specifications in our findings.…”

Difficult-to-Treat Antibiotic-Resistant Gram-Negative Pathogens in the Intensive Care Unit: Epidemiology, Outcomes, and Treatment

“…Cefepime is another antibiotic where the relationship between dosing and outcome is complicated; cefepime susceptibility is dose-dependent when the MIC is 4 and 8 μg/mL for Enterobacteriaceae. 71 Furthermore, cefepime can be removed by continuous renal replacement therapy making optimal dosing difficult but reliant on many different variables such as MIC and effluent rates. 72 As such, drug dosing should be monitored closely in patients with highly resistant gram-negative infections in the ICU and practices such as loading dose, prolonged infusions, therapeutic drug monitoring, and consultation to critical care pharmacists should be considered.…”

Artificial intelligence-accelerated high-throughput screening of antibiotic combinations on a microfluidic combinatorial droplet system

“…The different antibiotic concentrations for single antibiotic-based monotherapy were set based on the MIC values recorded in the literature. [44][45][46][47][48][49] First, the solutions of gentamicin (4 μg mL −1 and 6 μg mL −1 ), cefepime (25 ng mL −1 and 50 ng mL −1 ), chloramphenicol (2 μg mL −1 and 5 μg mL −1 ) and tetracycline (0.4 μg mL −1 and 0.8 μg mL −1 ) were prepared by dissolving the weighted powders in LB liquid medium, respectively. Afterwards, the E. coli stock solution (1 × 10 4 CFU mL −1 ), the prepared antibiotic solutions, and the LB liquid medium were loaded to the droplet generator through inlet I, inlet II and inlet III, respectively, according to the 3-stepped loading scheme (Table S5 †).…”