Cefepime versus extended spectrum β-lactamase-producing Enterobacteriaceae

Abstract

The objective of this study was to evaluate the susceptibility to cefepime of a large group of ESBL- producing enterobacteria recently isolated in a Brazilian teaching hospital . The study included 280 strains of ESBL-producing enterobacteria, isolated between 2005 and 2008. The presence of the genes blaCTX-M, blaTEM and blaSHV was determined by PCR and confirmed by nucleotide sequencing. Susceptibility testing for cefepime was performed by disc-diffusion, agar dilution method and E-test®. Among the isolates, 34 (12.1%) presented a cefepime inhibition zone > 21 and MIC < 8 mg/L by agar dilution and E-strip methods. The use of cefepime for the treatment of infections caused by ESBL-producing bacteria has been controversial. Some studies of PD/PK show the probability of achieving the required PD parameters for cefepime, when the MICs were < 8 mg/L, whereas others have reported therapeutic failure with the same MIC. Additional data is essential to come to terms about the report and treatment with cefepime in ESBL-producing organisms especially when these microorganisms are isolated from sterile sites and from critically ill patients.

Detecção De Betalactamase De Espectro Estendido Em Isolados De Enterobactérias Provenientes De Um Hospital Da Região De Santa Teresa-Es

“…O Cefepime é uma cefalosporina de 4ª geração, com amplo espectro de ação e tem sido muito indicado no tratamento de infecções de Enterobactérias, pois tem uma rápida penetração por meio da membrana exterior da célula. Um estudo realizado no Hospital da Universidade Federal do Paraná avaliou por diferentes métodos a sensibilidade de 280 cepas de enterobactérias produtoras de ESBL, ao cefepime, e 35 (12.1%) foram sensíveis com CMI (Concentração Mínima Inibitória) ≤ 8mcg/ml (NOGUEIRA et al, 2011). Já Mudshingkar e colaboradores (2014) encontraram sensibilidade ao cefepime em 65,4% das 219 amostras de enterobactérias produtoras de ESBL em seu estudo.…”