+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Cefepime, piperacillin-tazobactam, and the inoculum effect in tests with extended-spectrum beta-lactamase-producing Enterobacteriaceae

Cefepime, piperacillin-tazobactam, and the inoculum effect in tests with extended-spectrum beta-lactamase-producing Enterobacteriaceae

Antimicrobial Agents and ChemoTherapy 45(12): 3548-3554

There is little information about the clinical effectiveness of cefepime and piperacillin-tazobactam in the treatment of infections caused by extended-spectrum beta-lactamase (ESBL)-producing pathogens. Some inferences have been drawn from laboratory studies, which have usually involved only one or a few strains of ESBL-producing Klebsiella pneumoniae or Escherichia coli that produced only a limited range of ESBLs. Such studies are indirect, sometimes conflicting, indicators of efficacy. To extend previous laboratory findings, a study was designed to investigate organism-drug interactions by determining the in vitro activities of eight parenteral beta-lactam agents against 82 clinical and laboratory strains of Klebsiella, Escherichia, Enterobacter, Citrobacter, Serratia, Morganella, and Proteus species that produced 22 different ESBLs, alone or in combination with other beta-lactamases. Activities were determined in broth microdilution MIC tests using standard and 100-fold-higher inocula. An inoculum effect, defined as an eightfold or greater MIC increase on testing with the higher inoculum, was most consistently detected with cefepime, cefotaxime, and ceftriaxone and least frequently detected with meropenem and cefoteten. Piperacillin-tazobactam was intermediate between these two groups of agents. Although the inoculum effect is an in vitro laboratory phenomenon, if it has any predictive value in identifying increased risk of therapeutic failure in serious infections, these results support suggestions that cefepime may be a less-than-reliable agent for therapy of infections caused by ESBL-producing strains.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 010283926

Download citation: RISBibTeXText

PMID: 11709338

DOI: 10.1128/aac.45.12.3548-3554.2001

Related references

Comparative assessment of inoculum effects on the antimicrobial activity of amoxycillin-clavulanate and piperacillin-tazobactam with extended-spectrum beta-lactamase-producing and extended-spectrum beta-lactamase-non-producing Escherichia coli isolates. Clinical Microbiology and Infection 16(2): 132-136, 2010

Antimicrobial susceptibility and pharmacodynamic comparison of piperacillin-tazobactam and cefepime against enterobacteriaceae with extended-spectrum beta-lactamase. Abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy 41: 197, 2001

Pharmacodynamics of intermittent and continuous infusion piperacillin/tazobactam and cefepime against extended-spectrum beta-lactamase-producing organisms. International Journal of Antimicrobial Agents 26(2): 114-119, 2005

Pharmacodynamics of intermittent piperacillin/tazobactam and cefepime against extended-spectrum beta-lactamase producing organisms using Monte Carlo simulation. Pharmacotherapy 23(10): 1348-1349, 2003

Comparative activity of piperacillin/tazobactam against clinical isolates of extended-spectrum beta-lactamase-producing Enterobacteriaceae. ChemoTherapy 44(6): 377-384, 1998

Pharmacodynamics of continuous infusion cefepime and piperacillin-tazobactam against extended spectrum beta-lactamase producing organisms using Monte Carlo simulation. Pharmacotherapy 23(10): 1348, 2003

Empiric Piperacillin-Tazobactam versus Carbapenems in the Treatment of Bacteraemia Due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae. Plos one 11(4): E0153696, 2016

Mortality caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia; a case control study: alert to Enterobacteriaceae strains with high minimum inhibitory concentrations of piperacillin/tazobactam. Diagnostic Microbiology and Infectious Disease 94(3): 287-292, 2019

Antibiotic policy and prescribing strategies for therapy of extended-spectrum beta-lactamase-producing Enterobacteriaceae: the role of piperacillin-tazobactam. Clinical Microbiology and Infection 14(Suppl. 1): 181-184, 2008

Efficacies of piperacillin-tazobactam and cefepime in rats with experimental intra-abdominal abscesses due to an extended-spectrum beta-lactamase-producing strain of Klebsiella pneumoniae. Antimicrobial Agents and ChemoTherapy 41(5): 1053-1057, 1997

Carbapenems Versus Piperacillin-Tazobactam for Bloodstream Infections of Nonurinary Source Caused by Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae. Infection Control and Hospital Epidemiology 36(8): 981-985, 2015

Comparison of in vitro activity of piperacillin/tazobactam, cefepime, imipenem, and meropenem against extended-spectrum beta-lactamase and non-ESBL-producing K pneumoniac by time-kill methodology. Pharmacotherapy 21(10): 1273, 2001

Post-MERINO trial: Any role for piperacillin-tazobactam in treating bloodstream infections caused by extended-spectrum beta-lactamase producing Enterobacteriaceae?. International Journal of Antimicrobial Agents 53(5): 557-558, 2019

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. Bmc Infectious Diseases 17(1): 404, 2017

Inoculum Effect on the Efficacies of Amoxicillin-Clavulanate, Piperacillin-Tazobactam, and Imipenem against Extended-Spectrum beta-Lactamase ESBL-Producing and Non-ESBL-Producing Escherichia coli in an Experimental Murine Sepsis Model Experimental Th. 2013