Use of cefepime for the treatment of infections caused by extended spectrum β-lactamase–producing Klebsiella pneumoniae and Escherichia coli

LaBombardi, Vincent J.; Rojtman, Albert; Tran, Kim Van

doi:10.1016/j.diagmicrobio.2006.03.019

Cited by 23 publications

(22 citation statements)

References 6 publications

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“…Cefepime is more stable to hydrolysis by ESBLs than the 3GCs [21]; however, the rate of resistance to this fourth-generation cephalosporin (76%) was considerably high in this study. This antibiotic has been administered in recent years and widely used against different infections in Iran.…”

Section: Discussioncontrasting

confidence: 45%

“…Following carbapenems, the lowest rates of resistance in ESBLproducing isolates were observed for amikacin (21 Prevalence of bla SHV , bla TEM , and bla CTX-M genes and sequencing results PCR showed that 55.7% (n = 58), 30.7% (n = 32) and 45.2% (n = 47) of isolates contained bla SHV , bla TEM , and bla CTX-M genes, respectively. Coexistence of these genes was detected in 26 (34.7%) of isolates.…”

Section: Resistance Of K Pneumoniae Isolatesmentioning

confidence: 99%

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Genetic characterization of ESBL producing strains of Klebsiella pneumoniae from Tehran hospitals

Feizabadi

Mahamadi-Yeganeh

Mirsalehian

et al. 2010

J Infect Dev Ctries

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Introduction: This study was conducted to determine the genetic characterization of extended-spectrum beta-lactamase (ESBL) producing strains of Klebsiella pneumoniae isolated from Iranian patients in hospitals in Tehran. Methodology: Antibiotic susceptibility of 104 isolates was determined using the disk diffusion test. The Minimum Inhibitory Concentrations (MICs) of imipenem and meropenem were determined for isolates showing reduced susceptibility to carbapenems. The phenotypic confirmatory test (PCT) was used to screen the isolates for ESBL production. PCR was used to detect bla SHV , bla TEM and bla CTX-M and the amplicons from selected clones were sequenced. Isolates producing ESBLs were analyzed by pulsed-field gel electrophoresis (PFGE). Results: One isolate showed resistance to imipenem (MIC = 16 µg/ml). Resistance to amikacin and ciprofloxacin was 44.2% and 25.0%, respectively. ESBL production was detected in 72.1% (n = 75) of isolates. The prevalence of bla SHV , bla TEM and bla CTX-M genes among the isolates was 55.7% (n = 58), 30.7% (n = 32) and 45.2% (n = 47), respectively. The sequencing revealed the amplicons corresponding to bla

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Section: Discussioncontrasting

confidence: 45%

Section: Resistance Of K Pneumoniae Isolatesmentioning

confidence: 99%

Genetic characterization of ESBL producing strains of Klebsiella pneumoniae from Tehran hospitals

Feizabadi

Mahamadi-Yeganeh

Mirsalehian

et al. 2010

J Infect Dev Ctries

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“…A similar scenario was also observed with cefepime, for which there was no change of susceptibility breakpoints in the CLSI 2010 guidelines [10], resulting in some ESBL-producing K. pneumoniae isolates being reported as susceptible to cefepime. Clinical use of cefepime or third-generation cephalosporins with lower MICs (≤8 mg/L for cefepime and ≤4 mg/L for ceftazidime) for the treatment of infections caused by ESBL-producing E. coli and K. pneumoniae isolates has been studied [8,21,[24][25][26][27]. Pharmacokinetic/pharmacodynamic studies on third-generation cephalosporins and cefepime for the treatment of infections caused by ESBL-producing E. coli and K. pneumoniae isolates clearly demonstrated that the target attainment rates of these agents was almost 100% for isolates with MICs of ≤2 mg/L, <60% for isolates with MICs of 4 mg/L and 1% for isolates with MICs of 8 mg/L [27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and antimicrobial susceptibility profiles of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections in the Asia–Pacific region: 2008 results from SMART (Study for Monitoring Antimicrobial Resistance Trends)

Hsueh

Badal²,

Hawser³

et al. 2010

International Journal of Antimicrobial Agents

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“…Some clinical studies have reported successful treatment using cefepime in cases of ESBL-producing bacterial infection [19, 35]. However, several other studies have shown disappointing outcomes when using cefepime to treat bacteremic conditions [20, 23].…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of piperacillin-tazobactam, cefepime and ertapenem for the treatment of urinary tract infection caused by extended-spectrum beta-lactamase-producing Escherichia coli

et al. 2017

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BackgroundDue to limited therapeutic options, the spread of extended-spectrum beta-lactamases (ESBLs) have become a major public health concern. We conducted a prospective, randomized, open-label comparison of the therapeutic efficacy of piperacillin-tazobactam (PTZ), cefepime, and ertapenem in febrile nosocomial urinary tract infection with ESBL-producing Escherichia coli (ESBL-EC).MethodsThis study was conducted at three university hospitals between January 2013 and August 2015. Hospitalized adult patients presenting with fever were screened for healthcare-associated urinary tract infection (HA-UTI). When ESBL-EC was solely detected and susceptible to a randomized antibiotic in vitro, the case was included in the final analysis. Participants were treated for 10–14 days with PTZ, cefepime, or ertapenem.ResultsA total of 66 participants were evenly assigned to the PTZ and ertapenem treatment groups. After the recruitment of six participants, assignment to the cefepime treatment group was stopped because of an unexpectedly high treatment failure rate. The baseline characteristics of these participants did not differ from participants in other treatment groups. The clinical and microbiological response to PTZ treatment was estimated to be 94% and was similar to the response to ertapenem treatment. The efficacy of cefepime was 33.3%. In the cefepime group, age, Charlson comorbidity index, genotype, and minimal inhibitory concentration (MIC) did not significantly affect the success of treatment. Similarly, genotype seemed to be irrelevant with respect to clinical outcome in the PTZ group. Expired cases tended to involve septic shock with a high Charlson comorbidity index and high MIC.ConclusionResults from this study suggest that PTZ is effective in the treatment of urinary tract infection caused by ESBL-EC when the in vitro test indicates susceptibility. In addition, cefepime should not be used as an alternative treatment for urinary tract infection caused by ESBL-EC.Trial registrationThe trial was registered with the Clinical Research Information Service of Korea Centers for Disease Control and Prevention. (KCT0001895)

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Use of cefepime for the treatment of infections caused by extended spectrum β-lactamase–producing Klebsiella pneumoniae and Escherichia coli

Cited by 23 publications

References 6 publications

Genetic characterization of ESBL producing strains of Klebsiella pneumoniae from Tehran hospitals

Genetic characterization of ESBL producing strains of Klebsiella pneumoniae from Tehran hospitals

Epidemiology and antimicrobial susceptibility profiles of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections in the Asia–Pacific region: 2008 results from SMART (Study for Monitoring Antimicrobial Resistance Trends)

Randomized controlled trial of piperacillin-tazobactam, cefepime and ertapenem for the treatment of urinary tract infection caused by extended-spectrum beta-lactamase-producing Escherichia coli

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