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Susceptibilities of ESBL-producing Enterobacteriaceae to ertapenem, meropenem and piperacillin-tazobactam with and without clavulanic acid.
Chemotherapy. 2007; 53(3):185-9.C

Abstract

BACKGROUND

Faced with the extended-spectrum beta-lactamase (ESBL) pandemic, we compared the susceptibilities of ESBL-producing Enterobacteriaceae to ertapenem, meropenem and piperacillin-tazobactam with and without clavulanate.

METHODS

121 strains of Escherichia coli and Klebsiella were studied. 70 strains were originally reported as resistant to ceftazidime based upon disk diffusion; 51 strains were originally reported as sensitive to ceftazidime based upon previous guidelines of the National Committee for Clinical Laboratory Standards, but subsequently shown to be ESBL producers. Minimal inhibitory concentrations (MICs) of the strains towards ertapenem, meropenem and piperacillin-tazobactam were determined by Etest. The effect of adding clavulanate on the MICs was determined by performing the Etest, using plates containing 2 microg/ml of clavulanate.

RESULTS

The MIC90 of all isolates was 0.094 and 0.25 microg/ml for ertapenem, 0.032 and 0.064 microg/ml for meropenem, and 16 and 256 microg/ml for piperacillin-tazobactam with and without clavulanate, respectively.

CONCLUSIONS

ESBL-producing organisms were more susceptible to meropenem than to ertapenem, although the MICs to ertapenem were well within clinically achievable levels. Piperacillin-tazobactam was ineffective in a large percentage of isolates. The presence of clavulanate resulted in a 5-fold decrease in the MIC of ertapenem and in a drastic reduction in the MIC of piperacillin-tazobactam. The decrease observed with ertapenem is unlikely to be of clinical significance. Thus, in our hospital, ertapenem could be a good meropenem-sparing agent for infections due to ESBL-producing organisms. Piperacillin-tazobactam appeared to be a poor choice, as our isolates produce ESBLs which are not successfully inhibited by tazobactam.

Authors+Show Affiliations

Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17347564

Citation

Raveh, David, et al. "Susceptibilities of ESBL-producing Enterobacteriaceae to Ertapenem, Meropenem and Piperacillin-tazobactam With and Without Clavulanic Acid." Chemotherapy, vol. 53, no. 3, 2007, pp. 185-9.
Raveh D, Yinnon AM, Broide E, et al. Susceptibilities of ESBL-producing Enterobacteriaceae to ertapenem, meropenem and piperacillin-tazobactam with and without clavulanic acid. Chemotherapy. 2007;53(3):185-9.
Raveh, D., Yinnon, A. M., Broide, E., & Rudensky, B. (2007). Susceptibilities of ESBL-producing Enterobacteriaceae to ertapenem, meropenem and piperacillin-tazobactam with and without clavulanic acid. Chemotherapy, 53(3), 185-9.
Raveh D, et al. Susceptibilities of ESBL-producing Enterobacteriaceae to Ertapenem, Meropenem and Piperacillin-tazobactam With and Without Clavulanic Acid. Chemotherapy. 2007;53(3):185-9. PubMed PMID: 17347564.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Susceptibilities of ESBL-producing Enterobacteriaceae to ertapenem, meropenem and piperacillin-tazobactam with and without clavulanic acid. AU - Raveh,David, AU - Yinnon,Amos M, AU - Broide,Ellen, AU - Rudensky,Bernard, Y1 - 2007/03/07/ PY - 2005/06/12/received PY - 2006/02/27/accepted PY - 2007/3/10/pubmed PY - 2007/5/2/medline PY - 2007/3/10/entrez SP - 185 EP - 9 JF - Chemotherapy JO - Chemotherapy VL - 53 IS - 3 N2 - BACKGROUND: Faced with the extended-spectrum beta-lactamase (ESBL) pandemic, we compared the susceptibilities of ESBL-producing Enterobacteriaceae to ertapenem, meropenem and piperacillin-tazobactam with and without clavulanate. METHODS: 121 strains of Escherichia coli and Klebsiella were studied. 70 strains were originally reported as resistant to ceftazidime based upon disk diffusion; 51 strains were originally reported as sensitive to ceftazidime based upon previous guidelines of the National Committee for Clinical Laboratory Standards, but subsequently shown to be ESBL producers. Minimal inhibitory concentrations (MICs) of the strains towards ertapenem, meropenem and piperacillin-tazobactam were determined by Etest. The effect of adding clavulanate on the MICs was determined by performing the Etest, using plates containing 2 microg/ml of clavulanate. RESULTS: The MIC90 of all isolates was 0.094 and 0.25 microg/ml for ertapenem, 0.032 and 0.064 microg/ml for meropenem, and 16 and 256 microg/ml for piperacillin-tazobactam with and without clavulanate, respectively. CONCLUSIONS: ESBL-producing organisms were more susceptible to meropenem than to ertapenem, although the MICs to ertapenem were well within clinically achievable levels. Piperacillin-tazobactam was ineffective in a large percentage of isolates. The presence of clavulanate resulted in a 5-fold decrease in the MIC of ertapenem and in a drastic reduction in the MIC of piperacillin-tazobactam. The decrease observed with ertapenem is unlikely to be of clinical significance. Thus, in our hospital, ertapenem could be a good meropenem-sparing agent for infections due to ESBL-producing organisms. Piperacillin-tazobactam appeared to be a poor choice, as our isolates produce ESBLs which are not successfully inhibited by tazobactam. SN - 1421-9794 UR - https://www.unboundmedicine.com/medline/citation/17347564/Susceptibilities_of_ESBL_producing_Enterobacteriaceae_to_ertapenem_meropenem_and_piperacillin_tazobactam_with_and_without_clavulanic_acid_ L2 - https://www.karger.com?DOI=10.1159/000100516 DB - PRIME DP - Unbound Medicine ER -