Switching From Ceftriaxone to Cefotaxime Significantly Contributes to Reducing the Burden of Clostridioides difficile infections

Wendt, Sebastian; Ranft, Donald; Rodloff, Arne C.; Lippmann, Norman; Lübbert, Christoph

doi:10.1093/ofid/ofaa312

Cited by 10 publications

(7 citation statements)

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“…One explanation could be that ceftriaxone, as a biliary-excreted antibiotic, might be a stronger driver for resistance in Enterobacterales than cefotaxime [ 35 – 37 ]. The switch from ceftriaxone to cefotaxime might have also contributed to the drastic reduction of CDI (-65%), as proposed in a previous study [ 38 ]. Typically, third-generation cephalosporins are considered high-risk antibiotics for the development of CDIs [ 39 ].…”

Section: Discussionmentioning

confidence: 66%

Changes in antibiotic consumption, AMR and Clostridioides difficile infections in a large tertiary-care center following the implementation of institution-specific guidelines for antimicrobial therapy: A nine-year interrupted time series study

et al. 2021

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Background Institution-specific guidelines (ISGs) within the framework of antimicrobial stewardship programs offer locally tailored decision support taking into account local pathogen and resistance epidemiology as well as national and international guidelines. Objectives To assess the impact of ISGs for antimicrobial therapy on antibiotic consumption and subsequent changes in resistance rates and Clostridioides difficile infections (CDIs). Methods The study was conducted at the Leipzig University Hospital, a 1,451-bed tertiary-care medical center, and covered the years 2012 to 2020. Since 2014, ISGs were provided to optimize empirical therapies, appropriate diagnostics, and antimicrobial prophylaxis. We used interrupted time series analysis (ITSA) and simple linear regression to analyze changes in antimicrobial consumption, resistance and CDIs. Results Over the study period, 1,672,200 defined daily doses (DDD) of antibiotics were dispensed, and 85,645 bacterial isolates as well as 2,576 positive C. difficile cultures were collected. Total antimicrobial consumption decreased by 14% from 2012 to 2020, without clear impact of the deployment of ISGs. However, implementation of ISGs was associated with significant decreases in the use of substances that were rarely recommended (e.g., fluoroquinolones). Over the whole study period, we observed declining resistance rates to most antibiotic classes of up to 25% in Enterobacterales, staphylococci, and Pseudomonas aeruginosa. Switching from ceftriaxone to cefotaxime was associated with reduced resistance to third-generation cephalosporins. The number of CDI cases fell by 65%, from 501 in 2012 to 174 in 2020. Conclusions Well-implemented ISGs can have a significant, immediate, and lasting impact on the prescription behavior. ISGs might thereby contribute to reduce resistance rates and CDI incidences in the hospital setting.

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Section: Discussionmentioning

confidence: 66%

Changes in antibiotic consumption, AMR and Clostridioides difficile infections in a large tertiary-care center following the implementation of institution-specific guidelines for antimicrobial therapy: A nine-year interrupted time series study

et al. 2021

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“…Ceftriaxone can cause more gut microbiota disturbances after excretion into the bile whereas cefotaxime has lesser biliary excretion than ceftriaxone. In Leipzig University Hospital in Germany, a trend of decline in the use of ceftriaxone was noted with the increased use of cefotaxime, which resulted in a sudden decrease in the incidence of Clostridium difficile infections [ 37 ]. Due to biliary excretion associated with ceftriaxone, Enterobacteriaceae harboring high-level AmpC b-lactamase (HL-CASE) increases, which in turn results in a resistant infection that increases the use of carbapenems.…”

Section: Discussionmentioning

confidence: 99%

“…and Enterococci in the intestine, and (iii) cause diarrhea, urolithiasis, and cholelithiasis as compared to cefotaxime [31][32][33][34][35][36]. There is a higher incidence of Clostridium difficile infections with ceftriaxone as compared to cefotaxime [37]. Ceftriaxone can cause more gut microbiota disturbances after excretion into the bile whereas cefotaxime has lesser biliary excretion than ceftriaxone.…”

Section: Discussionmentioning

confidence: 99%

An In Vitro Susceptibility Study of Cefotaxime-Sulbactam on Clinical Bacterial Isolates From Various Regions in India: A Comparison With Ceftriaxone-Sulbactam

Gondane¹,

Pawar²

2023

Cureus

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Background and objective Combining sulbactam with cefotaxime/ceftriaxone augments its antimicrobial activity against β-lactamase-producing bacteria. They are widely used as empirical treatment for many clinical infections. However, there is a scarcity of data on the susceptibility of various organisms to these antibiotics in the Indian region. In light of this, the present in vitro study evaluated the susceptibility of bacterial isolates to cefotaxime-sulbactam and compared it with ceftriaxone-sulbactam. Methodology Clinical samples with positive bacterial cultures from various laboratories in India were subjected to antibiotic sensitivity testing using in vitro E-test strips and disk diffusion methods to determine the minimum inhibitory concentration (MIC) and zone of inhibition (ZOI), respectively. MIC 50 and MIC 90 values were determined along with the measurement of the ZOI for the effectiveness of antibiotics. Interpretations of MIC and ZOI values were made as per the criteria set by the Clinical and Laboratory Standards Institute (CLSI) guidelines to estimate the proportion of sensitive organisms. Results Among 400 clinical isolates evaluated, Escherichia coli (E. coli) (47.75%) was the most common organism isolated followed by Klebsiella (26%), Salmonella (7.75%), Proteus (3.8%), and Acinetobacter (2.8%). The mean ZOI was found significantly higher for E. coli, Klebsiella, and Salmonella in the cefotaxime-sulbactam group than in the ceftriaxone-sulbactam group. MIC 50 values for E. coli and Klebsiella were 0.25 and 0.19 µg/ml, respectively in the cefotaxime-sulbactam group as compared to 0.38 and 0.25 µg/ml, respectively for ceftriaxone-sulbactam. The proportion of sensitive isolates was also higher in the cefotaxime-sulbactam group for E. coli, Klebsiella , and Salmonella . Conclusions The in vitro effect of cefotaxime-sulbactam on organisms is similar to that of ceftriaxone-sulbactam in terms of MIC, ZOI, and proportion of sensitivity based on our study involving clinical isolates from various parts of India. Cefotaxime-sulbactam may be preferred in the empirical management of various clinical infections.

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“…In an antimicrobial stewardship (AMS) program, ceftriaxone was replaced (64% reduction in application density from 2013 to 2019) with cefotaxime. 43…”

Section: Ministry Of Health and Family Welfarementioning

confidence: 99%

Cefotaxime: A Reappraisal in Lower Respiratory Tract Infections

Jain

2023

F1000Res

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Lower respiratory Tract Infection (LRTI) is one of the fourth most common cause of mortality across the globe, and constitutes to be a major portion in critically ill patients associated with prolonged hospitalisation. Apart from age factor, other risk factors which predispose to the LRTI include poor sanitization, severe malnutrition, and lack of breast feeding for infants, HIV infection, lack of immunization, chronic illness, family history of LRTI and exposure to tobacco smoke/air pollutants. The third generation cephalosporins are used in management and treatment of gram-negative and gram-positive organism. Common bacteria implicated in these infections include S. pneumoniae, H. influenzae, Chlamydia pneumoniae, and Staphylococcus aureus. Third generation cephalosporins also target respiratory ailments like acute bronchitis, pneumonia, acute exacerbation of chronic lung diseases (such as COPD or bronchiectasis). Cefotaxime and ceftriaxone have been widely recommended in guidelines to be used for many infections and diseases, but, some serious adverse effects have been seen in past few years with ceftriaxone like cholelithiasis, encephalopathy, memory impairment, tonic- clonic seizures, neurotoxicity and auto-immune haemolytic anaemia. This fact compels us to revisit the clinically safer and efficacious drug Cefotaxime which have been used since decades but have not developed any resistance till date. Cefotaxime has been found to be well tolerated and not associated with hypo-prothrombinemia/coagulopathies, disulfiram-like reactions, as with other cephalosporins. It can readily cross the blood-brain barrier when administered intravenously and may treat gram-negative infections resistant to previous generations of cephalosporins. Cefotaxime, demonstrates good efficacy and safety in the management of LRTIs including CAP, hospital acquired/nosocomial acquired pneumonia, acute exacerbation of pneumonia and acute bronchitis caused by both gram positive as well as gram negative bacteria. Keywords: LRTI, Cefotaxime, cephalosporins, CAP, pneumonia, respiratory tract

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Switching From Ceftriaxone to Cefotaxime Significantly Contributes to Reducing the Burden of Clostridioides difficile infections

Cited by 10 publications

References 10 publications

Changes in antibiotic consumption, AMR and Clostridioides difficile infections in a large tertiary-care center following the implementation of institution-specific guidelines for antimicrobial therapy: A nine-year interrupted time series study

Changes in antibiotic consumption, AMR and Clostridioides difficile infections in a large tertiary-care center following the implementation of institution-specific guidelines for antimicrobial therapy: A nine-year interrupted time series study

An In Vitro Susceptibility Study of Cefotaxime-Sulbactam on Clinical Bacterial Isolates From Various Regions in India: A Comparison With Ceftriaxone-Sulbactam

Cefotaxime: A Reappraisal in Lower Respiratory Tract Infections

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