The Use of Cefepime for Treating AmpC β-Lactamase–Producing Enterobacteriaceae

Tamma, Pranita D.; Girdwood, Sonya Tang; Gopaul, Ravindra; Tekle, Tsigereda; Roberts, Ava A.; Harris, Anthony D.; Cosgrove, Sara E.; Carroll, Karen C.

doi:10.1093/cid/cit395

Cited by 143 publications

(88 citation statements)

References 39 publications

(61 reference statements)

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“…Using the current CLSI ceftriaxone breakpoint of 1 g/ml, we previously found that 100% of 96 organisms expressing AmpC ␤-lactamases had ceftriaxone MICs of Ͼ1 g/ml (11). Ceftriaxone has been found to be problematic for the treatment of these organisms, but broader-spectrum ␤-lactams have not demonstrated such problems (5).…”

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confidence: 99%

Determining the Optimal Ceftriaxone MIC for Triggering Extended-Spectrum β-Lactamase Confirmatory Testing

2014

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As routine testing of clinical isolates for extended-spectrum ␤-lactamase (ESBL) production (screen plus phenotypic confirmatory testing) is no longer required by the Clinical and Laboratory Standards Institute (CLSI), a number of clinical microbiology laboratories use ceftriaxone MICs as a proxy means of identifying bacteria as potential ESBL producers. Data from 1,386 clinical isolates suggest that a ceftriaxone MIC cutoff of 8 g/ml is an excellent predictor of ESBL production, with a positive predictive value and negative predictive value approaching 100% and 99.5%, respectively. In 2010, the Clinical and Laboratory Standards Institute (CLSI) lowered the ceftriaxone (and cefotaxime) breakpoint from 8 g/ml to 1 g/ml, and with that change, the recommendation for screening for extended-spectrum ␤-lactamase (ESBL) production became optional (1). This was in part due to the large workload imposed on clinical microbiology laboratories with phenotypic confirmatory ESBL testing (1). However, identification of organisms producing ESBLs still has important clinical implications. A portion of these organisms retain in vitro susceptibility to piperacillin-tazobactam and cefepime (2), even though these agents are generally considered inferior to carbapenem therapy for the treatment of invasive infections by ESBL-producing organisms (3-5).Without a method of alerting clinicians to the possibility that an agent may be an ESBL producer, potentially suboptimal therapy (e.g., cefepime or piperacillin-tazobactam) may be inadvertently prescribed. In addition, the absence of institutional epidemiological data on ESBLs can hamper efforts to control their spread within health care facilities (6). For these reasons, many clinical microbiology laboratories use ceftriaxone (or other thirdgeneration cephalosporin) MIC thresholds to indicate to clinicians that an organism is a possible ESBL producer or to trigger additional confirmatory phenotypic testing. If the ceftriaxone MIC threshold is lower than necessary, this practice has the potential to lead to the overuse of carbapenems or to needlessly increase the workload of microbiology laboratories (for institutions where confirmatory testing is still performed). If the ceftriaxone MIC threshold for ESBL identification is too high, appropriate infection control and treatment strategies may not be deployed. Our objective was to evaluate the sensitivities and specificities of various ceftriaxone MICs in determining the optimal threshold for identifying an organism as a potential ESBL producer.Microbiology methods. Blood isolates growing Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus mirabilis obtained from January 2007 to December 2013 were included. These bacteria were selected because the CLSI-recommended method for initial screening and phenotypic confirmatory testing is limited to these organisms (7). Clinical samples were processed at the Johns Hopkins Hospital Microbiology Laboratory according to standard operating procedures. Antimicrobial susceptibility t...

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Determining the Optimal Ceftriaxone MIC for Triggering Extended-Spectrum β-Lactamase Confirmatory Testing

2014

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“…Besides, the resistance nature of amikacin was changed to susceptible, hence, it could be used as an alternate treatment approach in complementary and alternate medicine against S. marcescens infections in near future. However, cefepime is the preferred drug and useful in patients with nosocomial infections caused by aerobic Gram-negative bacilli, even effective against microbes, which are resistant to most of the third-generation cephalosporins and gentamicin [26,27]. Biofield treated S. marcescens results in improved antimicrobial sensitivity of cefepime and gentamicin from resistant to susceptible, while decreased the MIC value as compared to the control.…”

Section: Antimicrobial Susceptibility Testmentioning

confidence: 99%

Assessment of Antibiogram of Biofield Energy Treated <i>Serratia marcescens</i>

Trivedi¹

2015

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Serratia marcescens (S. marcescens) has become an important nosocomial pathogens and increased resistantisolates were reported. The current study evaluates the impact of an alternate energy medicine i.e. Mr. Trivedi's biofield energy treatment on S. marcescens for changes in sensitivity pattern of antimicrobial, biochemical characteristics, and biotype number. S. marcescens cells were procured from MicroBioLogics Inc., USA in sealed pack bearing the American Type Culture Collection (ATCC 13880) number and divided into two groups, Group (Gr.) I: control and Gr. II: treated. Gr. II was further subdivided into two sub-groups, Gr. IIA and Gr. IIB. Gr. IIA was analyzed on day 10, while Gr. IIB was stored and analyzed on day 159 (Study I). After retreatment on day 159, the sample (Study II) was divided into three separate tubes as first, second and third tube, which were analyzed on day 5, 10 and 15 respectively. All experimental parameters were studied using the automated MicroScan Walk-Away ® system. Antimicrobial susceptibility results showed that 42.85% of tested antimicrobials results in altered sensitivity pattern, while decreased minimum inhibitory concentration values in 40.62% tested antimicrobials as compared to the control after biofield treatment on S. marcescens. The biochemical study showed that 12 out of 33 tested biochemicals (36.36%) were reported for alteration of biochemical reactions pattern as compared to the control. Biotype study showed an alteration in biotype number in all the experimental treated groups as compared to the control. These results suggested that biofield energy treatment has a significant impact on S. marcescens. Overall, it is expected that Mr. Trivedi's biofield energy treatment as an integrative medicine could be better therapy approach in near future.

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“…Baseline data were collected for the first day of detectable bacteremia, Patients who (1) received corticosteroid therapy $2 mg/kg or $20 mg daily for at least 14 days, (2) received biologic agents in the preceding 30 days, (3) received a solid organ transplant, (4) received a hematopoietic stem cell transplant in the preceding 1 year, (5) received cancer chemotherapy within 6 months, (6) had a congenital immunodeficiency, or (7) had HIV with CD4 #200 cells/mL were categorized as immunocompromised. 21 Multidrug resistant Gram-negative (MDRGN) organisms were defined as organisms not susceptible (resistant or intermediate) to at least 1 agent in at least 3 of 6 antimicrobial drug classes, including aminoglycosides, anti-pseudomonal penicillins, third-generation cephalosporins, anti-pseudomonal fluoroquinolones, aztreonam, orcarbapenems. 22 Escherichia coli and Klebsiella spp were identified as extended spectrum b-lactamase (ESBL) producing when there was an increase in the zone of inhibition of $5 mm with either ceftazidime or cefotaxime discs when tested in combination with discs containing clavulanic acid.…”

Section: Data Collectionmentioning

confidence: 99%

Empiric Combination Therapy for Gram-Negative Bacteremia

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT:Existing data do not demonstrate a need for combination therapy after antimicrobial susceptibility data indicate adequate in vitro activity with b-lactam monotherapy. However, the role of empirical combination therapy for the treatment of Gram-negative bacteremia in children remains unsettled. WHAT THIS STUDY ADDS:We conducted a retrospective, propensityscore matched study demonstrating no improvement in 10-day mortality of children who have Gram-negative bacteremia receiving empirical b-lactam and aminoglycoside combination therapy compared with b-lactam monotherapy, unless the bacteremic episode was attributable to a multidrug-resistant organism. METHODS:We conducted a retrospective cohort study of children treated for Gram-negative bacteremia at The Johns Hopkins Hospital from 2004 through 2012. We compared the estimated odds of 10-day mortality and the relative duration of bacteremia for children receiving empirical combination therapy versus empirical monotherapy using 1:1 nearest-neighbor propensity-score matching without replacement, before performing regression analysis. RESULTS:We identified 226 matched pairs of patients well balanced on baseline covariates. Ten-day mortality was similar between the groups (odds ratio, 0.84; 95% confidence interval [CI], 0.28 to 1.71). Use of empirical combination therapy was not associated with a decrease in the duration of bacteremia (20.51 days; 95% CI, 22.22 to 1.48 days). There was no survival benefit when evaluating 10-day mortality for the severely ill (pediatric risk of mortality III score $15) or profoundly neutropenic patients (absolute neutrophil count #100 cells/mL) receiving combination therapy. However, a survival benefit was observed when empirical combination therapy was prescribed for children growing multidrug-resistant Gram-negative organisms from the bloodstream (odds ratio, 0.70; 95% CI, 0.51 to 0.84). CONCLUSIONS:Although there appears to be no advantage to the routine addition of an aminoglycoside to a b-lactam as empirical therapy for children who have Gram-negative bacteremia, children who have risk factors for MDRGN organisms appear to benefit from this practice.

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The Use of Cefepime for Treating AmpC β-Lactamase–Producing Enterobacteriaceae

Abstract: Cefepime may be a reasonable option for the treatment of invasive infections due to AmpC β-lactamase-producing organisms, particularly when adequate source control is achieved.

Cited by 143 publications

References 39 publications

Determining the Optimal Ceftriaxone MIC for Triggering Extended-Spectrum β-Lactamase Confirmatory Testing

Determining the Optimal Ceftriaxone MIC for Triggering Extended-Spectrum β-Lactamase Confirmatory Testing

Assessment of Antibiogram of Biofield Energy Treated <i>Serratia marcescens</i>

Empiric Combination Therapy for Gram-Negative Bacteremia

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The Use of Cefepime for Treating AmpC β-Lactamase–Producing Enterobacteriaceae

Abstract: Cefepime may be a reasonable option for the treatment of invasive infections due to AmpC β-lactamase-producing organisms, particularly when adequate source control is achieved.

Cited by 143 publications

References 39 publications

Determining the Optimal Ceftriaxone MIC for Triggering Extended-Spectrum β-Lactamase Confirmatory Testing

Determining the Optimal Ceftriaxone MIC for Triggering Extended-Spectrum β-Lactamase Confirmatory Testing

Assessment of Antibiogram of Biofield Energy Treated &lt;i&gt;Serratia marcescens&lt;/i&gt;

Empiric Combination Therapy for Gram-Negative Bacteremia

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Assessment of Antibiogram of Biofield Energy Treated <i>Serratia marcescens</i>