Etest 3 14 6 6 14 7 31 2000 cefepime 1997 1998 22 22 43 1 Etest 10 10 oxacillin Staphylococcus aureus oxacillin staphylococciceftazidimeescherichia coli imipenem piperacillinceftazidimecefpirome cefoperazonesulbactam cefepime 11.91.01.00.5 0.5 Klebsiella sppimipenem piperacillin 7.2ceftazidime 0.2cefepime 0.2cefpirome 0.7cefoperazonesulbactam 1.5Citrobacter spp imipenem piperacillin 18.4 ceftazidime 19.5cefepime 0.6cefpirome 1.7cefoperazonesulbactam 5.8 Enterobacter spp imipenem cefepime 1.3cefpirome 5.3cefoperazonesulbactam 8.5 piperacillin 18.0ceftazidime 22.8 Proteus cefpirome cefepime imipenem 0.9 Serratia spp imipenem 4.5cefepime 6.5cefpirome ceftazidime 7.7 8.0 piperacillin cefoperazonesulbactam Pseudomonas aeruginosa ceftazidime 10.8cefepime 12.5cefoperazonesulbactam 13.2piperacillin 15.7 cefpirome imipenem 20 Acinetobacter sppcefoperazonesulbactam 0.3imipenem 3.1ceftazidime 4.5 cefepime 5.1cefpirome 5.4 cefoperazonesulbactam 5.9 cefepime Key words: cefepime lactamsetestsusceptibilitydrug resistance 1 2 3 Etest 5 21 16 1997 4 1998 2 5 2 Enterobacter spp piperacillin ceftazidime 1998 6.6 3.7 Acinetobacter spp cefepime cefpirome 3.0 2.91998 Pseudomonas aeruginosa imipenem 2.5 ceftazidime 1997 oxacillin staphylococci 15.4
1998 1.6 5 2000 2 cefepime 43 2000 4 9 Etest I 43 2000 4 9 oxacillin Staphylococcus aureusoxacillin coagulase negative StaphylococciEscherichia coliklebsiella spp., Citrobacter freundiienterobacter spp., indole positive ProteusSerretia spp., Acinetobacter spp., P. aeruginosa 10 10 Etest A B piperacillin oxacillinceftazidimecefpiromecefepimecefoperazonesulbactam2:1 imipenem Etest Mueller Hinton BBL U.S.A Mueller Hinton Macfaland 0.5 Mueller Hinton 90 3 Etest Staphylococci 3524 1618 35 MIC MIC NCCLS 6 E. coli ATCC 25922S. aureus ATCC 29213P. aeruginosa ATCC 27853E. coli ATCC 35218cefoperazone sulbactam Ronald Jones Enterobacter cloacae SD AmpCCitrobacter diversus D 11E. coli D 05 S. aureus D 05coagulase negative Staphylococci II 10 Table 1 406 oxacillin S. aureus ceftazidime 23.4 2.0 MIC90 imipenem 0.0047gmL oxacillin0.5gmlcefpirome 2gmLcefepime cefoperazonesulbactam 4gmLceftazidime16gmL 336 oxacillin coagulase negative staphylococci ceftazidime74.72.1 MIC90 imipenem 0.0064gmL oxacillin0.5gml cefpirome1gmlcefepime cefoperazone sulbactam3gmlceftazidime16gml 405 E. coli piperacillin 11.9ceftazidime cefpirome 1.0cefepime cefoperazonesulbactam 0.5 imipenem E. coli MIC90 cefepime0.19gml cefpirome imipenem0.25gmlceftazidime cefoperazone
Table 1 Antimicrobial activity of 7 β lactams tested against clinical isolates Organism notested Oxacillin sensitive S. aureus 406 Oxacillin sensitive and -coagrase negative staphylococci 336 Escherichia coli 405 Klebsiella spp 405 Citrobacter freundii 359 Enterobacter spp 400 Indolpositive Proteus 348 Serratia spp 399 Acinetobacter spp 353 Pseudomonas aeruginosa 408 Antibiotics MICµgmL MICµgmL Category 50 90 range S R oxacillin 038 05 0094 2 1000 00 ceftazidime 12 16 4 48 234 20 cefepime 3 4 1 8 1000 00 cefpirome 15 2 05 4 1000 00 CPSB 2 4 075 12 1000 00 imipenem 0032 0047 0016 025 1000 00 oxacillin 025 05 0064 2 1000 00 ceftazidime 8 16 15 32 747 21 cefepime 1 3 025 8 1000 00 cefpirome 05 1 0125 4 1000 00 CPSB 15 3 019 8 1000 00 imipenem 0032 0064 0012 032 1000 00 piperacillin 2 256 0064 256 783 119 ceftazidime 025 15 0047 192 983 10 cefepime 0064 019 0023 256 993 05 cefpirome 0094 025 0023 256 990 10 CPSB 025 15 0023 256 988 05 imipenem 025 025 0125 075 1000 00 piperacillin 6 32 038 256 872 72 ceftazidime 025 075 0047 48 998 02 cefepime 0064 038 0023 256 995 02 cefpirome 0094 038 0023 256 990 07 CPSB 025 2 0064 256 975 15 imipenem 025 038 0094 1 1000 00 piperacillin 3 256 05 256 786 184 ceftazidime 075 256 005 256 794 195 cefepime 0064 15 0032 256 975 06 cefpirome 0125 4 0047 256 950 17 CPSB 075 32 0064 256 868 58 imipenem 038 15 0025 4 1000 00 piperacillin 2 256 025 256 738 180 ceftazidime 05 256 0064 256 710 228 cefepime 0094 3 0016 256 960 13 cefpirome 019 8 0023 256 917 53 CPSB 05 48 0016 256 853 85 imipenem 038 1 0032 6 998 00 piperacillin 075 32 0016 256 891 63 ceftazidime 0125 2 0047 256 934 26 cefepime 0064 025 016 16 994 00 cefpirome 0125 05 0016 16 994 00 CPSB 1 3 0032 256 971 17 imipenem 2 4 0125 32 948 09 piperacillin 3 256 0094 2 794 150 ceftazidime 038 16 4 48 892 80 cefepime 0125 8 1 8 910 65 cefpirome 0125 8 0023 256 900 78 CPSB 20 2 0064 256 830 142 imipenem 038 15 005 32 952 45 piperacillin 12 48 038 256 717 59 ceftazidime 4 8 025 256 912 45 cefepime 3 12 0064 256 892 51 cefpirome 2 8 0094 256 909 54 CPSB 2 4 0125 128 994 03 imipenem 025 05 0064 32 969 31 piperacillin 6 256 0032 256 836 157 ceftazidime 2 32 0064 256 841 108 cefepime 4 48 025 256 701 125 cefpirome 8 256 019 356 571 260 CPSB 6 96 025 256 752 132 imipenem 15 32 0125 32 745 203 cefoperazonesulbactam2:1 susceptible, resistance
sulbactam1.5gmlpiperacillin256gml 405 Klebsiella spp MIC90 cefepimecefpirome imipenem0.38gml ceftazidime0.75gmlcefoperazonesulbactam2gmlpiperacillin32gml 0.21.57.2 359 Citrobacter freundii cefepime imipenem MIC90 1.5gmL imipenem cefepime 0.6 cefpirome 1.7MIC90 4gmLcefoperazonesulbactam 5.8MIC90 32gmLceftazidime 19.5MIC90 256gmLpiperacillin 18.4MIC90256gmL 400 Enterobacter sppmic90 imipenem 0MIC90 1gmLcefepime 1.3M IC90 3gmLcefpirome 5.3MIC90 8gmL cefoperazonesulbactam 8.5MIC90 0.5gmL piperacillin 18.0MIC90256gmLceftazidime 22.8MIC90256gmL 348 indole positive Proteus MIC90 cefepime0.25gml cefpirome 0.5gmL MIC90 ceftazidime2g ml 2.6cefoperazonesulbactam3gmL 1.7imipenem4gmL 0.9piperacillin32gmL 6.3 399 Serratia sppmic90 imipenem1.5gml 4.5cefoperazonesulbactam2gmL 14.2cefepime 8gmL 6.5cefpirome8gmL 7.8 ceftazidime16gml 8.0piperacillin 256gmL 15.0 353 Acinetobacter sppmic90 imipenem0.5gml 3.1 cefoperazonesulbactam4gml 0.3ceftazidime8gmL 4.5cefpirome8gmL 5.1cefepime12gmL 5.1piperacillin48gmL 5.9 408 P. aeruginosa MIC90 ceftazidime32gml 10.8cefepime48 gml 12.5cefoperazonesulbactam96g ml 13.2imipenem32gmL 20.3 piperacillin256gml 15.7cefpirome256gmL 26.0 III 3 Table 2 2000 oxacillin S. aureus oxacillin staphylococci caftazidime 2.1 2000 E. coli piperacillin 11.9 1997 14.6 1998 12.6 A C imipenem 0.51.0 Yagi 7 Klebsiella sppimipenem 0.27.2 ceftazidimecefepime cefpirome 0.2 0.7 ImipenemC. freundiienterobacter sppimipenem B B 8 Serratia spp imipenem 4.5 1997 4.5 1998 4.4 B Serratia spp 45 cefepime cefepime C 910 cefepime Indolpositive Proteus 1998 2000
Table 2 Comparison of resistance during 1997, 1998, and 2000 Organisms Antibiotics Percentage 1997 1998 2000 Oxacillin sensitive oxacillin 00 00 00 Staphyrococcus aureus ceftazidime 64 05 20 cefepime 00 00 00 cefpirome 00 05 00 CPSB 00 00 00 imipenem 00 00 00 Oxacillin sensitive and oxacillin 00 00 00 coagrase negative ceftazidime 154 16 21 Staphylococci cefepime 00 00 00 cefpirome 00 00 00 CPSB 00 00 00 imipenem 00 00 00 Escherichia coli piperacillin 146 126 119 ceftazidime 05 00 10 cefepime 05 00 05 cefpirome 05 00 10 CPSB 05 00 05 imipenem 05 00 00 Klebsiella spp piperacillin 72 96 72 ceftazidime 18 09 02 cefepime 00 00 02 cefpirome 14 05 07 CPSB 27 14 15 imipenem 00 00 00 Citrobacter freundii piperacillin 261 226 184 ceftazidime 250 221 195 cefepime 00 00 06 cefpirome 11 21 17 CPSB 83 63 58 imipenem 00 00 00 Enterobacter spp piperacillin 185 251 180 ceftazidime 205 242 228 cefepime 10 05 13 cefpirome 39 43 53 CPSB 151 106 85 imipenem 05 05 00 Indol positrive Proteus piperacillin 87 80 63 ceftazidime 05 30 26 cefepime 05 05 00 cefpirome 31 05 00 CPSB 15 00 17 imipenem 10 50 09 Serratia spp piperacillin 250 223 150 ceftazidime 95 68 80 cefepime 50 58 65 cefpirome 85 63 78 CPSB 235 160 142 imipenem 45 44 45 Acinetobacter spp piperacillin 312 302 59 ceftazidime 80 40 45 cefepime 50 80 51 cefpirome 121 150 54 CPSB 05 05 03 imipenem 25 65 31 Pseudomonas aeruginosa piperacillin 201 185 157 ceftazidime 114 87 108 cefepime 91 91 125 cefpirome 279 272 260 CPSB 137 115 132 imipenem 224 249 203 cefoperazonesulbactam2:1
Acinetobacter spp cefoperazonesulbactam 0.3 Acinetobacter spp A B C D 3.1 imipenem cefoperazonesulbactam Acinetobacter spp imipenem cefoperazonesulbactam P. aeruginosa cefpirome 26.0 imipenem 20.3 Imipenem ceftazidime 9.5 imipenem 10 D2 cefepime cefepime P. aeruginosa ceftazidime imipenem Acinetobacter spp 1 Yoshihara EGotoh NNishino Tet al.: Protein D2porinofthePseudomonas aeruginosa outer membrane bears the protease activity. FEBS Lett 394: 1791821996 2 Masuda NSakagawa EOhya Set al.: Substrate specificities of MexAB OprMMexCD OprJand MexXY OprM efflux pumps in Pseudomonas aeruginosaantimicrob Agents Chemother 443322 33272000 3 Ubukata KShibasaki YYamamoto Ket al.: Associationofamino acid substitutionsinpenicillin binding protein 3 with lactam resistance in lactamase negative ampicillin resistant Haemophilus influenzaeantimicrob Agents Chemother 45: 1693 16992001 4!: Eest 48: 5245302000 5!: Eest 2 50: 2592652002 6 National Committee for Clinical Laboratory Standard. 2000. Methods for dilution antimicrobial susceptibility test for bacteria. M 7 A 5. Vol 20. No.2 7 Yagi TKurokawa HShibata Net al.: A preliminary survey of extended spectrum lactamases ESBLsin clinical isolates of Klebsiella pneumoniae and Escherichia coli in Japan. FEMS Microbiol Lett 184: 53562000 8 Hirakata YIzumikawa KYamaguchi Tet al.: Rapid detection and evaluation of clinical characteristics of emerging multiple drug resistant gram negative rods carrying the Metallo lactamase gene blaimpantimicrob. agents chemother. 42: 200620111998 9 Hiraoka MInoue MMitsuhashi S: Hydrolytic rate at low drug concentration as a limiting factor in resistance to newer cephalosporins. Rev Infect Dis. 10: 7467511988 10 Hiraoka MMasuyoshi SMitsuhashi Set al.: Cephalosporinase interactions and antimicrobial activity of BMY 28142ceftazidime and cefotaxime. JAntibiotTokyo41: 86931988
Evaluation of the antimicrobial activity of lactam antibiotics by Etest against clinical isolates Yoshikazu IshiiJimena AlbaSoichiro Kimura and Keizo Yamaguchi Department of MicrobiologyToho University School of Medicine5 21 16 Omori nishiota ku Tokyo 143 8540Japan Susceptibility to 7 lactam antibiotics: cefepimecefpiromeceftazidimecefoperazonesulbactam imipenemand piperacillingram negativeor oxacillingram positivewas studied. A common protocol and methodetest; AB BiodiskSwedenwas used at 43 medical centers. No strains resistant to these lactams except for ceftazidime andor cefpirome were found in oxacillin susceptible Staphylococcus aureus and coagulase negative staphylococci. In Escherichia coli11.9 of clinical strains were resistant to piperacillinwhile only 0.5 1.0 were resistant to other antibiotics. All clinical strains of Klebsiella spp. were susceptible to imipenem. Isolates of Enterobacer spp. and Citrobacter spp. were most susceptible to imipenem. Isolates of Serratia spp. were more susceptible to imipenem4.5 resistancecefepime6.5 cefpirome7.7and ceftazidime7.7than other lactams tested. No indole positive Proteus was resistant to cefepime or cefpiromebut 0.9 of strains were resistant to imipenem. Isolates of Pseudomonas aeruginosa were more susceptible to ceftazidime10.8 resistanceand cefepime12.5 than cefoperazonesulbactam13.2piperacillin15.7imipenem20.3and cefpirome26.0 These results clearly indicate that emergence of strains resistant to cefepime is lower than to other lactam antibiotics tested.