Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2024

Open Access 01-12-2024 | Cefepime | Research

Antimicrobial activity of cefepime-tazobactam combination against extended spectrum beta-lactamase and/or AmpC beta-lactamase- producing gram-negative bacilli

Authors: Basma Ahmed Elawady, Noha Refaat Mahmoud, Hala El-Sayed Badawi, Azza Essam Eldin Badr, Noha Mahmoud Gohar

Published in: BMC Infectious Diseases | Issue 1/2024

Login to get access

Abstract

Background

The problem of resistance to beta-lactam antibiotics, which is caused by ESBL and AmpC β-lactamases, is getting worse globally. Infections caused by bacterial isolates harboring these enzymes are difficult to treat with carbapenems being the sole effective treatment option for such infections. The objective of this study was to determine the frequency of ESBLs and AmpC-producing Gram-negative bacilli isolated from clinical specimens and to evaluate the sensitivity of cefepime-tazobactam combination against them.

Methods

This is an observational cross-sectional study carried out on 100 Gram-negative bacilli at Theodor Bilharz Research Institute Hospital during the period from February 2015 to January 2016. ESBL production was screened by using the disc diffusion test followed by confirmation by the combined disc confirmatory test, the screening for AmpC production was conducted using the cefoxitin disc test, which was subsequently confirmed by the AmpC disc test. Isolates confirmed positive for ESBL and/ or AmpC production were investigated for their susceptibility to antibiotics.

Results

Among 100 Gram-negative bacilli, 44 isolates were confirmed as ESBL producers by the combined disc confirmatory test out of 56 isolates that tested positive for ESBL production through the disc diffusion test. The presence of AmpC production was assessed using the cefoxitin disc test, 32 isolates were screened to be AmpC producers, and the AmpC disc test confirmed AmpC production in 9 isolates of them. Using the Mast® D68C set, 32 isolates were ESBL producers, 3 were AmpC producers, and 4 isolates were ESBL/AmpC co-producers. The highest sensitivity was to cefepime-tazobactam (91.48%) followed by the carbapenems.

Conclusion

Cefepime-tazobactam showed remarkable activity against ESBL and/or AmpC-producing Gram-negative bacilli and may be considered as a therapeutic alternative to carbapenems.
Literature
1.
2.
Iredell J, Brown J, Tagg K. Antibiotic resistance in Enterobacteriaceae: mechanisms and clinical implications. BMJ. 2016;352:h6420.CrossRefPubMed
3.
Rao MJ, Harle S, Padmavathy M. Prevalence of Extended Spectrum Beta-lactamases and AmpC beta-lactamases in clinical isolates of gram-negative bacilli at a tertiary care hospital. J Evol Med Dent. 2018;7(39):2278–4748.
4.
Tekele S, Teklu D, Tullu K, et al. Extended-spectrum Beta-lactamase and AmpC beta-lactamases producing Gram-negative bacilli isolated from clinical specimens at International Clinical Laboratories, Addis Ababa, Ethiopia. PLoS ONE. 2020;15(11):e0241984.CrossRefPubMedPubMedCentral
5.
Ambler R. The structure of b-lactamases. Philos Trans R Soc Lond B Biol Sci. 1980;289(1036):321–31.CrossRefPubMed
6.
7.
Lee J, Bae I, Lee S. New defnitions of extended-spectrum b-Lactamase conferring Worldwide Emerging Antibiotic Resistance. Med Res Rev. 2011;32(1):216–32.CrossRef
8.
Gutierrez G, Ba ~ no J. Current options for the treatment of infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae in different groups of patients. Clin Microbiol Infect. 2019;25(8):932–42.CrossRef
9.
Grabein B, Ebenhoch M, KühnenE, et al. Calculated parenteral initial treatment of bacterial infections: infections with multi-resistant gram-negative rods– ESBL producers, carbapenemase-producing Enterobacteriaceae, carbapenem-resistant Acinetobacter baumannii. GMS Infect Dis. 2020;8:1–22.
10.
Kaur R, Gautam V, Singhal L, et al. Antimicrobial activity of cefepime–tazobactam combination tested against clinical isolates of Enterobacteriaceae. J Antibiot. 2014;67:603–4.CrossRef
11.
Monica Cheesbrough. District laboratory practice in tropical countries. Cambridge: Cambridge University Press; 2009. Part 2, Second Edition.
12.
Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing, 25th informational supplement; Wayne, PA, USA. 2015; vol. 35, no.3.
13.
Giske C, Martinez L, Cantón R. EUCAST guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance. 2013; Version 1.0 (2013-12-11).
14.
Singhal S, Mathur T, Khan S, et al. Evaluation of methods forAmpC β-lactamase in Gram-negative clinical isolates from tertiary care hospitals. Ind J Med Microb. 2005;23(2):120–4.CrossRef
15.
16.
17.
Khater E, Sherif H. Rapid detection of extended-spectrum β-lactamase (ESBL) producing strain of Escherichia coli in urinary tract infections patients in Benha University Hospital, Egypt. Br Microbiol Res J. 2014;4:443–53.CrossRef
18.
Amer S, El-Hefnawy A, Abouseada N, et al. Detection of extended-spectrum beta-lactamase-producing strains among clinical isolates of Escherichia coli and Klebsiella pneumoniae in Alexandria using Chrom-ID ESBL agar and molecular techniques. EJMM. 2017;26(2):9–17.CrossRef
19.
Gharib M, Ouda N, Saeed M, et al. Prevalence of Extended Spectrum Beta Lactamase producers in an Egyptian critical Care Center. Egypt J Med Micro. 2009;18(4):139–46.
20.
Amer R, El-Baghdady K, Kamel I, et al. Prevalence of Extended Spectrum Beta- Lactamase genes among Escherichia coli and Klebsiella pneumoniae clinical isolates. Egypt J Microbiol. 2019;54:91–101.
21.
Badawi H, Diab M, El Said M. Impact of antibiotic policy in a tertiary care research institute hospital in Egypt: three years experience. Resear J Med Sci. 2007;3(1):84–91.
22.
Fam N, Lefon-Guibout V, Fouad S, et al. CTX-M-15-producing Escherichia coli clinical isolates in Cairo (Egypt), including isolates of clonal complex ST10 and clones ST131, ST73, and ST405 in both community and hospital settings. Microb Drug Resist. 2011;17:67–73.CrossRefPubMed
23.
Shash R, Elshimy A, Soliman M, et al. Molecular characterization of extended-spectrum β-lactamase Enterobacteriaceae isolated from Egyptian patients with community-and hospital-acquired urinary tract infection. Am J Trop Med Hyg. 2019;100(3):522–8.CrossRefPubMed
24.
Mohamed E, Khairy R, Abdelrahim S. Prevalence and molecular characteristics of ESBL and AmpC β -lactamase producing Enterobacteriaceae strains isolated from UTIs in Egypt. Antimicrob Resist Infect Control. 2020; (9): 198.
25.
Salah M, Azab M, Halaby H, et al. Mutations in β lactamases detected in multidrug-resistant gram-negative bacteria isolated from community-acquired urinary tract infections in Assiut, Egypt. Afr J Microbiol Res. 2016;10:1938–43.CrossRef
26.
Oberoi L, Singh N, Sharma P, et al. ESBL, MBL and AmpC β lactamases producing superbugs– Havoc in the Intensive Care units of Punjab India. J Clin Diagn Res. 2013;7(1):70–3.PubMedPubMedCentral
27.
Elsharkawy A, Mansour M, Esmaeel A, et al. Detection of extended-spectrum and plasmid-mediated AmpC β-lactamases in nosocomial Klebsiella isolates. J Microbiol Infect Dis. 2013;3(1):24–30.CrossRef
28.
Fam N, Gamal D, Sorur A, et al. Detection of plasmid-mediated AmpC beta-lactamases in clinically significant bacterial isolates in a research institute hospital in Egypt. Life Sci J. 2013;10:2.
29.
Haider M, Rizvi M, Fatima N, et al. Necessity of detection of extended spectrum beta-lactamase, AmpC and metallo-beta-lactamases in Gram-negative bacteria isolated from clinical specimens. Mullar J Med Scien Res. 2014;5(1):23–8.CrossRef
30.
Sultan A, Gouda N, Eldegla H, et al. Healthcare-Associated infections caused by Gram-negative Bacilli in adult intensive care units: identification of AmpC Beta-lactamases mediated Antimicrobial Resistance. Egypt J Med Microbiol. 2019;28(2):61–8.CrossRef
31.
Yilmaz N, Agus N, Bozcal E, et al. Detection of plasmid-mediated AmpC β-lactamase in Escherichia coli and Klebsiella pneumoniae. Indian J Med Microbiol. 2013;31:53–9.
32.
Pitout J, Lee P, Moore K, et al. Detection of AmpC β-lactamases in Escherichia coli, Klebsiella spp., Salmonella spp. and Proteus mirabilis in a regional clinical microbiology laboratory. J Clin Microbiol. 2010;16(2):166–70.
33.
Sridhar P, Manipura S, Rama P, et al. Extended-spectrum beta-lactamases producing Escherichia coli and Klebsiella pneumonia: a multi-centric study across Karnataka. J Lab Physicians. 2014;6(1):7–13.CrossRef
34.
35.
Meini S, Tascini C, Cei M, et al. AmpC β-lactamase-producing enterobacterales: what a clinician should know. Infection. 2019;47:363–75.CrossRefPubMed
36.
Yusuf I, Haruna M. Detection of AMPC and ESBL Producers among Enterobacteriaceae in a Tertiary Health Care in, Kano- Nigeria. Int J Sci Tech. 2013;3:220–5.
37.
Nourrisson C, Tan R, Hennequin C, et al. The MAST® D68C test: an interesting tool for detecting extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. Eur J Clin Microbiol Infect Dis. 2015;34:975–83.CrossRefPubMed
38.
Rizi K, Mosavatc A, Youssefi M, et al. High prevalence of blaCMY AmpC beta-lactamase in ESBL co-producing Escherichia coli and Klebsiella spp clinical isolates in the northeast of Iran. J Global Antimicrob Resist. 2020;22:477–82.CrossRef
39.
Elsayed N, Awad A, Omar M, et al. Rapid Simultaneous detection of AmpC and ESBLs among Enterobacteriaceae using MastD68C detection set and possible therapeutic options. Egyp J Med Micro. 2015;24(3):1–12.
40.
Ghafur A, Pushparaju R, Nalini S, et al. Sensitivity pattern of Gram-negative bacteria to the new β-lactam/ β-lactamase inhibitor combination: Cefepime/tazobactam. J Clin Microbiol Infec Dis. 2012;2(1):5–8.CrossRef
41.
Owusu F, Obeng-Nkrumah N, Gyinae E, et al. Occurrence of Carbapenemases, extended-spectrum Beta-lactamases and AmpCs among Beta-lactamase-producing gram-negative Bacteria from clinical sources in Accra, Ghana. Antibiotics. 2023;12:1016.CrossRefPubMedPubMedCentral
42.
Lai C, Chen C, Lu Y, et al. Appropriate composites of cefoperazone–sulbactam against multidrug-resistant organisms. Infect drug Resist. 2018;11(2):1441–5.CrossRefPubMedPubMedCentral
43.
Mushtaq S, Garello P, Vickers A, et al. Cefepime/tazobactam compared with other tazobactam combinations against problem Gram-negative bacteria International. J Antimicrob Agents. 2021;57(5):106318.CrossRef
44.
Mudshingkar S, Dedwal A, Palewar M, et al. Cefepime/tazobactam-a promising BL-BLI combination against multi-drug resistant gram-negative bacteria. Inter J Healthc Biomedical Res. 2014;2(3):127–8.
45.
Susan M, Hariharan T, Sonya J. A comparative in vitro study of Cephalosporin/Beta-lactamase inhibitor combinations against Gram-negative bacilli. Indian J Physiol Pharmacol. 2013;57(4):425–31.PubMed
46.
Sader H, Castanheira M, Mendes R, et al. Antimicrobial activity of high-proportion cefepime-tazobactam (WCK 4282) against a large number of Gram-negative isolates Collected Worldwide in 2014. Antimicrob Agents Chemother. 2017;61(4):e02409–16.CrossRefPubMedPubMedCentral
Metadata
Title
Antimicrobial activity of cefepime-tazobactam combination against extended spectrum beta-lactamase and/or AmpC beta-lactamase- producing gram-negative bacilli
Authors
Basma Ahmed Elawady
Noha Refaat Mahmoud
Hala El-Sayed Badawi
Azza Essam Eldin Badr
Noha Mahmoud Gohar
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2024
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-024-09296-y

Other articles of this Issue 1/2024

BMC Infectious Diseases 1/2024 Go to the issue

Research

Explaining the barriers faced by veterinarians against preventing antimicrobial resistance: an innovative interdisciplinary qualitative study

Research

Post-recovery health domain scores among outpatients by SARS-CoV-2 testing status during the pre-Delta period

Research

The practice and evaluation of antifungal stewardship programs at a tertiary first-class hospital in China

Research

HIV protease resistance mutations in patients receiving second-line antiretroviral therapy in Libreville, Gabon

Research

Remote surveillance and detection of SARS-CoV-2 transmission among household members in King County, Washington

Research

The burden of skin and soft tissue, bone and joint infections in an Australian cohort of people who inject drugs
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits