title: Alternatives to carbapenems in ESBL-producing Escherichia coli infections.
abstract: OBJECTIVE
  The authors had for objective to assess the activity of a wide panel of antibiotics on extended-spectrum-β-lactamase producing Escherichia coli isolates (ESBL-Ec), because of the sharp increase of their frequency, leading to an increased use of carbapenems.
  
  
  METHODS
  We selected 100 ESBL-Ec in which ESBLs were identified by PCR and sequencing, between 2009 and 2010. We determined the MICs of amoxicillin-clavulanate, piperacillin-tazobactam, temocillin, mecillinam, cefoxitin, cefotaxime, ceftazidime, aztreonam, tigecycline, nitrofurantoin, and fosfomycin using reference methods. The susceptibility profiles were defined according to EUCAST 2012 recommendations.
  
  
  RESULTS
  Fosfomycin, nitrofurantoin, and pivmecillinam were active against more than 90% of isolates and remain excellent choices for the oral treatment of urinary tract infections (UTIs). Temocillin and piperacillin-tazobactam are also good candidates for the treatment of pyelonephritis or bloodstream infections. Only 27, 23, and 8% of isolates were susceptible to ceftazidime, cefepime, and cefotaxime, respectively.
  
  
  CONCLUSIONS
  Our study results prove that in many cases, there are non-carbapenem alternatives for the treatment of ESBL-Ec infections.
authors: Service de bactériologie, centre hospitalier universitaire de Besançon, 25030 Besançon, France.
authors: D
authors: D
authors: Fournier
authors: C
authors: C
authors: Chirouze
authors: J
authors: J
authors: Leroy
authors: P
authors: P
authors: Cholley
authors: D
authors: D
authors: Talon
authors: P
authors: P
authors: Plésiat
authors: X
authors: X
authors: Bertrand
mesh_terms: D000900:Anti-Bacterial Agents / Q000145:classification / Q000494:pharmacology / Q000627:therapeutic use*; D015780:Carbapenems; D004269:DNA, Bacterial / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification / Q000378:metabolism; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D029968:Escherichia coli Proteins / Q000032:analysis / Q000235:genetics; D006801:Humans; D008565:Membrane Proteins / Q000032:analysis / Q000235:genetics; D008826:Microbial Sensitivity Tests; D016415:Sequence Alignment; D012689:Sequence Homology, Nucleic Acid; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000032:analysis / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; C414316:Blr protein, E coli; D015780:Carbapenems; D004269:DNA, Bacterial; D029968:Escherichia coli Proteins; D008565:Membrane Proteins; D001618:beta-Lactamases