Efficacy of amoxycillin-clavulanate in an experimental model of murine pneumonia caused by AmpC-non-hyperproducing clinical isolates of Escherichia coli resistant to cefoxitin

Clin Microbiol Infect. 2008 Jun;14(6):582-7. doi: 10.1111/j.1469-0691.2008.01948.x. Epub 2008 Feb 22.

Abstract

The algorithms included in most automated systems used for antimicrobial susceptibility testing (e.g., Vitek 2) consider that Escherichia coli isolates resistant to cefoxitin are AmpC-hyperproducers and, consequently, resistant also to amoxycillin-clavulanate. However, a recent study revealed that 30% of E. coli clinical isolates resistant to cefoxitin remained susceptible in vitro to amoxycillin-clavulanate. The aim of the present study was to evaluate the in-vivo efficacy of amoxycillin-clavulanate in the treatment of an experimental model of pneumonia, using two clonally related isolates (with identical repetitive extragenic palindromic sequence (REP)-PCR patterns) of AmpC-non-hyperproducing and OmpF-lacking E. coli (Ec985 and Ec571) that were resistant to cefoxitin and susceptible to cefotaxime and amoxycillin-clavulanate. MICs were determined using a microdilution technique, and in-vitro bactericidal activity was tested using time-kill assays. The in-vivo efficacy of amoxycillin, amoxycillin-clavulanate and cefotaxime against both isolates was tested in a murine pneumonia model using immunocompetent C57BL/6 mice. Ec571 (a TEM-1/2 producer) was resistant to amoxycillin, whereas Ec985 (a TEM-1/2 non-producer) was susceptible. Amoxycillin, amoxycillin-clavulanate and cefotaxime were bactericidal for Ec985, and amoxycillin-clavulanate and cefotaxime were bactericidal for Ec571 at different concentrations and time-points, as determined using time-kill assays. Treatment with amoxycillin, amoxycillin-clavulanate and cefotaxime reduced the bacterial lung concentration of Ec985 compared with non-treated controls (p <0.05), whereas amoxycillin-clavulanate and cefotaxime showed efficacy against Ec571 when compared with the control and amoxycillin groups (p <0.05). Regardless of the exact underlying mechanism(s) of resistance, amoxycillin-clavulanate was effective in the experimental murine model in the treatment of pneumonia caused by AmpC-non-hyperproducing strains of E. coli resistant to cefoxitin.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amoxicillin / blood
  • Amoxicillin / therapeutic use
  • Amoxicillin-Potassium Clavulanate Combination / pharmacokinetics
  • Amoxicillin-Potassium Clavulanate Combination / therapeutic use*
  • Animals
  • Anti-Bacterial Agents / blood
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Proteins / antagonists & inhibitors*
  • Cefotaxime / blood
  • Cefotaxime / therapeutic use
  • Cefoxitin / pharmacology
  • Drug Therapy, Combination
  • Escherichia coli / drug effects*
  • Escherichia coli / enzymology
  • Escherichia coli Infections / drug therapy*
  • Female
  • Lung / microbiology
  • Mice
  • Mice, Inbred C57BL
  • Microbial Sensitivity Tests
  • Pneumonia, Bacterial / drug therapy*
  • Specific Pathogen-Free Organisms
  • beta-Lactam Resistance*
  • beta-Lactamase Inhibitors*
  • beta-Lactamases

Substances

  • Anti-Bacterial Agents
  • Bacterial Proteins
  • beta-Lactamase Inhibitors
  • Cefoxitin
  • Amoxicillin-Potassium Clavulanate Combination
  • Amoxicillin
  • AmpC beta-lactamases
  • beta-Lactamases
  • Cefotaxime