What does the susceptible-dose dependent interpretive category for cefepime in ESBL-producing bacteria?

J Chemother. 2017 Jun;29(3):189-194. doi: 10.1080/1120009X.2015.1120407. Epub 2016 Feb 6.

Abstract

In this study, we investigated the frequency of isolates included in the susceptible-dose dependent (SDD) category, according to the Clinical and Laboratory Standards Institute guidelines, carrying blaTEM, blaSHV and blaCTX genes among 92 Klebsiella pneumoniae and 80 Enterobacter cloacae clinical isolates. The presence of one or more extended-spectrum β-lactamases (ESBLs) genes was observed in 64% K. pneumoniae and 69% E. cloacae isolates. Nineteen isolates were included in SDD interpretive category criteria, of which 15 carried ESBL genes (seven K. pneumoniae and eight E. cloacae). Considering the high proportion of ESBL gene-containing isolates included in the SDD category (79%), we recommend that physicians exercise caution in the use of cefepime for treatment of infections caused by these isolates, reducing possible therapeutic failure, particularly in cases of ESBL-producing bacterial strains.

Keywords: Cefepime; Enterobacter cloacae; Extended-spectrum β-lactamase; Klebsiella pneumoniae; Minimum inhibitory concentration; Susceptible-dose dependent.

MeSH terms

  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / metabolism
  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Proteins / genetics
  • Bacterial Proteins / metabolism*
  • Brazil
  • Cefepime
  • Cephalosporins / adverse effects
  • Cephalosporins / metabolism
  • Cephalosporins / pharmacology*
  • Cephalosporins / therapeutic use
  • Drug Resistance, Bacterial
  • Drug Resistance, Multiple, Bacterial
  • Enterobacter cloacae / classification
  • Enterobacter cloacae / drug effects*
  • Enterobacter cloacae / enzymology
  • Enterobacter cloacae / growth & development
  • Enterobacteriaceae Infections / drug therapy
  • Enterobacteriaceae Infections / microbiology
  • Genes, Bacterial
  • Humans
  • Inactivation, Metabolic
  • Intensive Care Units
  • Klebsiella Infections / drug therapy
  • Klebsiella Infections / microbiology
  • Klebsiella pneumoniae / classification
  • Klebsiella pneumoniae / drug effects*
  • Klebsiella pneumoniae / enzymology
  • Klebsiella pneumoniae / growth & development
  • Microbial Sensitivity Tests
  • Molecular Typing
  • Practice Guidelines as Topic
  • beta-Lactamases / genetics
  • beta-Lactamases / metabolism*

Substances

  • Anti-Bacterial Agents
  • Bacterial Proteins
  • Cephalosporins
  • Cefepime
  • beta-Lactamases