title: Cefditoren: Comparative efficacy with other antimicrobials and risk factors for resistance in clinical isolates causing UTIs in outpatients.
abstract: BACKGROUND
  To investigate a possible role of Cefditoren, a recently marketed in Greece third-generation oral cephalosporin in urinary infections of outpatients.
  
  
  METHODS
  During a multicenter survey of Enterobacteriaceae causing UTIs in outpatients during 2005-2007, Cefditoren MICs were determined by agar dilution method in a randomly selected sample of uropathogens. Susceptibility against 18 other oral/parenteral antimicrobials was determined according to Clinical and Laboratory Standards Institute methodology.
  
  
  RESULTS
  A total of 563 isolates (330 Escherichia coli, 142 Proteus mirabilis and 91 Klebsiella spp) was studied; MIC50/MIC90 of Cefditoren was 0.25/0.5 mg/L respectively, with 97.1% of the isolates being inhibited at 1 mg/L. All 12 strains producing ESBLs or AmpC enzymes were resistant to cefditoren. Susceptibility rates (%) for amoxicillin/clavulanic acid, cefuroxime axetil, cefotaxime, ciprofloxacin, trimethoprim/sulfamethoxazole and fosfomycin were 93.1- 94.1- 96.8-93.1-71.9 and 92.8% respectively. Cefditoren MIC was significantly higher in nalidixic/ciprofloxacin non-susceptible strains; resistance to cefditoren was not associated with resistance to mecillinam, fosfomycin nitrofurantoin and aminoglycosides. Multivariate analysis demonstrated history of urinary infection in the last two weeks or three months as risk factors for cefditoren resistance.
  
  
  CONCLUSIONS
  Cefditoren exhibited enhanced in vitro activity against the most common uropathogens in the outpatient setting, representing an alternative oral treatment option in patients with risk factors for resistance to first-line antibiotics.
authors.affiliation: Department of Microbiology, P. and A. Kyriakou Children's Hospital, Thibon and Levadeias, 11527 Athens, Greece.
authors.forename: Despina
authors.initials: D
authors.lastname: Hatzaki
authors.forename: Garyphallia
authors.initials: G
authors.lastname: Poulakou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Katsarolis
authors.forename: Niki
authors.initials: N
authors.lastname: Lambri
authors.forename: Maria
authors.initials: M
authors.lastname: Souli
authors.forename: Ioannis
authors.initials: I
authors.lastname: Deliolanis
authors.forename: Georgios K
authors.initials: GK
authors.lastname: Nikolopoulos
authors.forename: Evangelia
authors.initials: E
authors.lastname: Lebessi
authors.forename: Helen
authors.initials: H
authors.lastname: Giamarellou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010045:Outpatients; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; C073460:cefditoren