title: Ceftriaxone-sulbactam combination in rabbit endocarditis caused by a strain of Klebsiella pneumoniae producing extended-broad-spectrum TEM-3 beta-lactamase.
abstract: We studied the activity of the combination of sulbactam and ceftriaxone against a Klebsiella pneumoniae strain producing TEM-3, a new extended-broad-spectrum beta-lactamase, in an endocarditis model. In vitro, ceftriaxone was strongly inactivated in the presence of TEM-3 (MBC, 128 micrograms/ml with an inoculum of 5 x 10(5) CFU/ml). A marked inoculum effect was demonstrated with sulbactam: effective concentrations of inhibitor needed to reduce the MIC and MBC of ceftriaxone to similar levels increased from 1 microgram/ml in the presence of an inoculum of 5 x 10(5) CFU/ml to 20 micrograms/ml in the presence of an inoculum of 1 x 10(7) CFU/ml. In vivo, sulbactam given at 200 mg/kg of body weight every 12 h, a dosage higher than that previously reported to be effective against rabbit endocarditis caused by other microorganisms, was not sufficient to restore the complete activity of ceftriaxone given at 30 mg/kg once daily for 4 days. This insufficient activity may be correlated with the presence of a high level of beta-lactamase inside the vegetations, as indicated by a quantitative in vitro assay of beta-lactamase activity in the cardiac vegetation, suggesting an insufficient inactivation of the extended-broad-spectrum beta-lactamase in vivo.
authors.affiliation: Hôpital Claude Bernard, Institut National de la Santé et de la Recherche Médicale U.13, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Caron
authors.forename: L
authors.initials: L
authors.lastname: Gutmann
authors.forename: A
authors.initials: A
authors.lastname: Bure
authors.forename: B
authors.initials: B
authors.lastname: Pangon
authors.forename: J M
authors.initials: JM
authors.lastname: Vallois
authors.forename: A
authors.initials: A
authors.lastname: Pechinot
authors.forename: C
authors.initials: C
authors.lastname: Carbon
mesh_terms: D000818:Animals; D002443:Ceftriaxone / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006207:Half-Life; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology; D008826:Microbial Sensitivity Tests; D011817:Rabbits; D013407:Sulbactam / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D002443:Ceftriaxone; D001618:beta-Lactamases; D013407:Sulbactam