title: Temocillin use in England: clinical and microbiological efficacies in infections caused by extended-spectrum and/or derepressed AmpC β-lactamase-producing Enterobacteriaceae.
abstract: BACKGROUND
  Temocillin, a β-lactam stable against most β-lactamases [including extended-spectrum β-lactamases (ESBLs) and derepressed AmpC cephalosporinases (dAmpC)], has been suggested as an alternative to carbapenems when Pseudomonas can be excluded. Aims To assess temocillin clinical and microbiological cure rates (CCR and MCR) in infection caused by ESBL/dAmpC-producing Enterobacteriaceae and the effects of different dosage regimens.
  
  
  METHODS
  Data were collected retrospectively from patients treated for at least 3 days with temocillin for urinary tract infection (n = 42), bloodstream infection (n = 42) or hospital-acquired pneumonia (n = 8) in six centres in the UK.
  
  
  RESULTS
  Data on 92 infection episodes were collected. Overall CCR and MCR were 86% and 84% respectively; ESBL/dAmpC status had no effect. Significantly higher CCR and MCR occurred in patients treated with temocillin at optimal dosage [2 g twice daily or renally adjusted equivalent (ORAE)] compared with those treated with a suboptimal dosage (<2 g twice daily ORAE) (CCR 91% and MCR 92% versus CCR 73% and MCR 63%). This difference was more pronounced in the ESBL/dAmpC-positive subset (CCR 97% and MCR 97% versus CCR 67% and MCR 50%).
  
  
  CONCLUSIONS
  Clinical and microbiological efficacies of temocillin are unaffected by ESBL/dAmpC production, confirming its potential application as a carbapenem-sparing agent. Both CCR and MCR are optimized by a regimen of 2 g twice daily ORAE in ESBL/dAmpC-positive infection.
authors.affiliation: Royal Free Hampstead NHS Trust, London, UK. indran.balakrishnan@nhs.net
authors.forename: Indran
authors.initials: I
authors.lastname: Balakrishnan
authors.forename: F Mustafa
authors.initials: FM
authors.lastname: Awad-El-Kariem
authors.forename: Adnan
authors.initials: A
authors.lastname: Aali
authors.forename: Prasanna
authors.initials: P
authors.lastname: Kumari
authors.forename: Rohinton
authors.initials: R
authors.lastname: Mulla
authors.forename: Benny
authors.initials: B
authors.lastname: Tan
authors.forename: Daniel
authors.initials: D
authors.lastname: Brudney
authors.forename: David
authors.initials: D
authors.lastname: Ladenheim
authors.forename: Anan
authors.initials: A
authors.lastname: Ghazy
authors.forename: Imran
authors.initials: I
authors.lastname: Khan
authors.forename: Nilangi
authors.initials: N
authors.lastname: Virgincar
authors.forename: Shabnam
authors.initials: S
authors.lastname: Iyer
authors.forename: Stephane
authors.initials: S
authors.lastname: Carryn
authors.forename: Sebastien
authors.initials: S
authors.lastname: Van de Velde
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000378:metabolism*; D016360:Clostridioides difficile / Q000187:drug effects; D004739:England; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use*; D018410:Pneumonia, Bacterial / Q000188:drug therapy; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy; D014552:Urinary Tract Infections / Q000188:drug therapy; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D010406:Penicillins; C031367:temocillin; C048795:AmpC beta-lactamases; D001618:beta-Lactamases