title: Cefepime versus extended spectrum β-lactamase-producing Enterobacteriaceae.
abstract: The objective of this study was to evaluate the susceptibility to cefepime of a large group of ESBL- producing enterobacteria recently isolated in a Brazilian teaching hospital . The study included 280 strains of ESBL-producing enterobacteria, isolated between 2005 and 2008. The presence of the genes blaCTX-M, blaTEM and blaSHV was determined by PCR and confirmed by nucleotide sequencing. Susceptibility testing for cefepime was performed by disc-diffusion, agar dilution method and E-test®. Among the isolates, 34 (12.1%) presented a cefepime inhibition zone > 21 and MIC < 8 mg/L by agar dilution and E-strip methods. The use of cefepime for the treatment of infections caused by ESBL-producing bacteria has been controversial. Some studies of PD/PK show the probability of achieving the required PD parameters for cefepime, when the MICs were < 8 mg/L, whereas others have reported therapeutic failure with the same MIC. Additional data is essential to come to terms about the report and treatment with cefepime in ESBL-producing organisms especially when these microorganisms are isolated from sterile sites and from critically ill patients.
authors.affiliation: Hospital de Clínicas, Universidade Federal do Paraná, Rua Comendador Macedo 275, Centro, Curitiba, Parana, Brazil. keitenogueira@hotmail.com
authors.forename: Keite da Silva
authors.initials: Kda S
authors.lastname: Nogueira
authors.forename: Alessandra Vale
authors.initials: AV
authors.lastname: Daur
authors.forename: Iara Taborda de Messias
authors.initials: IT
authors.lastname: Reason
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Gales
authors.forename: Libera Maria Dalla
authors.initials: LM
authors.lastname: Costa
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D000077723:Cefepime; D002511:Cephalosporins / Q000494:pharmacology*; D004755:Enterobacteriaceae / Q000145:classification / Q000187:drug effects* / Q000201:enzymology; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime; D001618:beta-Lactamases