Etest! 5 7 99 997 Etest 0 0 oxacillin Staphylococcus aureus staphylococci ceftadizime Escherichia coli. Klebsiella spp Citrobacter spp Enterobacter spp 0.5 Serratia spp. 5... cefoperazonesulbactam Proteus cefoperazonesulbactam 0.5Pseudomonas aeruginosa 9..7 Imipenem P. aeruginosa.9 Key words: lactamsetestsusceptibilitydrug resistance A D A C D A C D B A D 5 ESBL C 5 7
Cefepime 50 Pseudomonas aeruginosa 997 7 Etest Etest 99 997 I 997 99 99 oxacillin Staphylococcus aureus, oxacillin staphylococci, Escherichia coli, Klebsiella spp., Citrobacter spp., Enterobacter spp., Proteus, Serretia spp., Acinetobacter spp., P. aeruginosa 0 0 Etest AB oxacillin cefoperazonesulbactam Etest Mueller Hinton BBL U.S.A. Mueller Hinton Macfaland 0.5 Mueller Hinton 90 Etest Staphylococci 5 5 MIC Etest E. coli ATCC 59, S. aureus ATCC 9, P. aeruginosa ATCC 75, E. coli ATCC 5cefoperazone/sulbactam Ronald Jones Enterobacter cloacae SDAmpCCitrobacter diversus DE. coli D05S. aureus D05 staphylococci II Table 09 oxacillin S. aureus.9 0.5 99.0 0.5 MIC90 0.0 ml oxacillin0.75 ml ml cefoperazonesulbactam ml ml 9 oxacillin staphylococci : 7.:. MIC90 0.09 ml oxacillin ml.5 ml mlcefoperazone sulbactam ml ml 09 E. coli. E. coli MIC90 0.5 ml 0. ml, 0.5 /ml, 0.75 / ml, cefoperazonesulbactam.5/ml, 9/mL 9 Klebsiella spp MIC90 0.5 ml 0. ml, 0.5 ml
Table Antimicrobial activity of 7 tested βlactams against clinical isolates99 Organism notested Antibiotics MICµgmL MICµgmL Category 50 90 range S R S. aureus 09 oxacillin 00 7 075 0 0 9 0 990 0 0 Coagrasenegative staphylococci 9 oxacillin 050 7 0 9 05 05 0 0 7 0 0 0 E. coli 09 090 7 05 050 050 9 05 00 00 0 9 075 77 0 0 0 0 0 Klebsiella spp 9 090 7 05 00 00 9 00 05 00 00 0 5 7 7 05 75 99 99 977 0 9 09 Citrobacter freundii 9 090 00 7 5 75 990 9 Enterobacter spp 0 00 050 00 075 09 7 79 97 99 9 5 0 Indolpositive Proteus 00 05 050 050 09 09 0 9 950 990 79 0 0 50 Serratia spp 0 00 05 090 7 7 05 09 0 9 9 9 79 9 5 0 Acinetobacter spp 00 00 5 00 0 05 0 0 9 9 7 0 5 0 990 95 0 0 0 50 5 P. aeruginosa 9 05 05 7 05 09 05 0 790 5 70 9 5 7 9 7 9 cefoperazonesulbactam: susceptible resistance
0.5 MIC90 certazidime0.5 mlcefoperazonesulbactam ml9 ml 0.9. 9. 9 Citrobacter spp MIC90.5 ml ml MIC90 ml cefoperazonesulbactam ml ml.... 0 Enterobacter spp MIC90 ml ml mlcefoperazonesulbactam ml ml 0.50.5.0. 5.. 00 Proteus MIC90 0.5 ml 0.75 ml 0.5MIC90.5 mlcefoperazonesulbactam ml ml mlcefoperazonesulbactam.0.0 0 Serratia spp MIC90 ml. ml. ml 5. ml.cefoperazonesulbactam ml.0 ml. 00 Acinetobacter spp MIC90 ml.5cefoperazonesulbactam ml 0.5 ml.0 ml.0 ml 5.0 ml 0. 9 P. aeruginosa MIC90 ml mlcefoperazonesulbactam ml ml ml ml.7 9..5.9.5 7. III Etest Etest 09 E. coli 9 Klebsilella spp ESBL Klebsiella spp cefoperazonesulbactam Klebsiella spp. Kebsiella oxytoca K. oxytoca K 9 K. oxytoca NCCLS ESBL 0 E. coli 7.7 Klebsiella spp 5.0 ESBL Yagi 997 99 9 05 E. coli 979 Klebsiella pneumoniae ESBL E. coli 0.K. penumoniae 0. ESBL ESBL Yagi ESBL ESBL E. coli 0 Klebsiella spp 7 ESBL Proteus NCCLS ESBL.0 cefoperazonesulbactam 5 ESBL ampc Citrobacter spp., Enterobacter spp. Serratia spp. AmpC
AmpC 5 Ceftazidime Citrobacter spp., Enterobacter spp. Serratia spp.... NCCLS Citrobacter spp., Enterobacter spp. Serratia spp. 00.5 5. Hiraoka MIC 00M AmpC Ceftazidime AmpC Serratia spp. PCR blaimp blaimp Serratia spp IMP 00 Acinetobacter spp 90 cefoperazonesulbactam99.0 9.5 0.5.0.0.0 A C D B Acinetobacter baumanii 5 Serratia spp PCR blaimp blaimp IMP 9 P. aeruginosa :. 0. 79.0cefoperazonesulbactam7.0 9. 5. Ceftazidime 9 PCR blaimp Imipenem P. aeruginosa.9 P. aeruginosa D Piperacillincefepim cefoperazonesulbactam oxacillin staphylococci Ceftazidime S. aureus 0.5 staphylococci. Table Variations in resistance patterns compared 997 and 99 Resistance variation Antibiotics Organisms Change of variation Increase Enterobacter spp Enterobacter spp Acinetobacter spp IndPosProteus Acinetobacter spp 5 5 50 0 0 50 5 5 Decrease cephoperazone sulbactam C. freundii S. aureus Coag.Neg staphylococci Acinetobacter spp Enterobacter spp Serratia spp 5 0 0 5 0 5 0 IndPosProteus:Indolepositive Proteus CoagNegstaphylococci: Coagrasenegative staphylococci
staphylococci 997 99 Table Enterobacter spp..55. Ceftazidime Enterobacter spp.0.5. Acinetobacter spp.5.0.0 Proteus.0 5.0 Acinetobacter spp..5.5 Citrobacter spp... S. aureus.0.5 staphylococci5.. Acinetobacter spp..0.0 cefoperazonesulbactam Enterobacter spp5. 0. Serratia spp..5.0 P. aeruginosa Acinetobacter spp. Ambler R P, Coulson A F, Frere J M, et al.: A standard numbering scheme for the class A βlactamases. Biochem J. 7: 970, 99 Bush K, Jacoby G A, Medeiros A A: A functional classification scheme for βlactamases and its correlation with molecular structure. Antimicrob Agents Chemother. 9:, 995 Knothe HShah PKrcmery Vet al.: Transferable resistance to cefotaximecefoxitincefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection. : 5 79 Ishii Y, Ohno A, Taguchi H, et al.: Cloning and sequence of the gene encoding a cefotaximehydrolyzing class A βlactamase isolated from Escherichia coli. Antimicrob Agents Chemother. 9: 975, 995 5 Sanders C C: Chromosomal cephalosporinases responsible for multiple resistance to newer βlactam antibiotics. Ann. Rev. Microbiol. : 5759, 97 Yoshihara E, Gotoh N, Nishino T, et al.: Protein D porin of the Pseudomonas aeruginosa outer membrane bears the protease activity. FEBS Lett. 9: 79, 99 7 Masuda N, Sakagawa E, Ohya S, et al.: Substrate specificities of MexABOprM, MexCDOprJ, and MexXYoprM efflux pumps in Pseudomonas aeruginosa. Antimicrob Agents Chemother. : 7, 000!: Eest : 550000 9 Wu S W, Dornbusch K, Norgren M, et al.: Extended spectrum βlactamase from Klebsiella oxytoca, not belonging to the TEM or SHV family. J Antimicrob Chemother. 0:, 99 0 NCCL: Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved StandardFifth Edition. NCCLS document M 7A 5. NCCLS: Wayne, Pennsylvania, 000 Yagi T, Kurokawa H, Shibata N, et al.: A preliminary survey of extendedspectrum βlactamases ESBLsin clinical isolates of Klebsiella pneumoniae and Escherichia coli in Japan. FEMS Microbiol Lett. : 55, 000 Galleni M, Lindberg F, Normark S, et al.: 9. Sequence and comparative analysis of three Enterobacter cloacae ampc βlactamase genes and their products. Biochem J. 50: 7570, 9 Hiraoka M, Inoue M, Mitsuhashi S: Hydrolytic rate at low drug concentration as a limiting factor in resistance to newer cephalosporins. Rev Infect Dis. 0: 775, 9 Hiraoka M, Masuyoshi S, Mitsuhashi S, et al.: 9. Cephalosporinase interactions and antimicrobial activity of BMY, and cefotaxime. J AntibiotTokyo: 9, 9 5 AfzalShah M, Woodford N, Livermore D M: Characterization of OXA5, OXA, and OXA7, molecular class D βlactamases associated with carbapenem resistance in clinical isolates of Acinetobacter baumannii. Antimicrob Agents Chemother 5: 55, 000 Chu Y W, AfzalShah M, Houang E T, et al.: IMP, a novel metallobetalactamase from nosocomial Acinetobacter spp. collected in Hong Kong between 99 and 99. Antimicrob Agents Chemother. 5: 707, 00 7 LopezHernandez S, Alarcon T, LopezBrea M: Biochemical characterization of chromosomal cepha-
losporinases from isolates belonging to the Acinetobacter baumannii complex. Clin Microbiol Infect. 7:, 00 Vahaboglu H, Coskunkan F, Tansel O, et al.: Clinical importance of extendedspectrum βlactamase PERtypeproducing Acinetobacter spp. and Pseudomonas aeruginosa strains. J Med Microbiol 50: 5, 00 Evaluation of antimicrobial activity of lactam antibiotics by Etest against clinical isolates Yoshikazu IshiiLing Ma and Keizo Yamaguchi Department of MicrobiologyToho University School of Medicine5 Omorinishi OtakuTokyo, Japan Susceptibility to 7 βlactam antibiotics,,,, cefoperazone sulbactam, and for gramnegativesor oxacillinfor grampositiveswas studied using a common protocol and methodetest; AB Biodisk, Swedenin medical centers. No strains resistant to these βlactams except for and/or were found in oxacillinsusceptible Staphylococcus aureus and coagulasenegative staphylococci. In Escherichia coli,. of clinical strains were resistant to, while no strains were observed resistant to other antibiotics. All clinical strains of Klebsiella spp. were susceptible to and. Isolates of Enterobacer spp. and Citrobacter spp. were most susceptible to and. Isolates of Serratia spp. were more susceptible to.% resistance,5.,.,and.than other βlactams tested. Isolates of indolepositive Proteus were more susceptible to cefoperazonesulbactam0 resistance, 0.5, 0.5, and.0than other βlactams tested. Isolates of Pseudomonas aeruginosa were more susceptible to.7 resistanceand 9.than cefoperazonesulbactam.5,.5,.9,and7..these results clearly indicate that emergence of resistant strains to is lower than other βlactam antibiotics tested.