title: Comparative in-vitro activity of cefoperazone-tazobactam and cefoperazone-sulbactam combinations against ESBL pathogens in respiratory and urinary infections.
abstract: BACKGROUND
  The emergence and subsequent widespread dissemination of bacterial resistance to a variety of beta-lactam antibiotics by the elaboration of ESBL (Extended Spectrum Beta Lactamase) poses a serious threat to the effective use of beta lactam antibiotics and cephalosporins. Cefoperazone combination with the beta lactamase inhibitor tazobactam would be a strong basis for rational therapeutics when dealing with ESBL producing pathogen mediated infections.
  
  
  OBJECTIVE
  The objective of the study was to investigate the in vitro efficacy of cefoperazone-tazobactam and cefoperazone-sulbactam against ESBL producing respiratory and urinary pathogens.
  
  
  METHODS
  54 samples (34 samples of urine and 20 samples of sputum) were collected from 9 hospitals in Mumbai. The pathogens isolated from urine included E. coli (n = 27), K. pneumoniae (n = 6), and Serratia marcescens (n = 1). The pathogens isolated from sputum included Pseudomonas aeruginosa (n = 5), Streptococcus pneumoniae (n = 1) and Klebsiella pneumoniae (n = 14). The Kirby Bauer disc diffusion method was used to evaluate the susceptibility of the isolated pathogens to cefoperazone-tazobactam and cefoperazone-sulbactam.
  
  
  RESULTS
  In sputum samples, all the isolates of Pseudomonas aeruginosa were susceptible to cefoperazone-tazobactam while one isolate was resistant to cefoperazone-sulbactam. Streptococcus pneumoniae and Klebsiella pneumoniae were sensitive to both the antibiotic formulations. In uropathogens, higher susceptibility rates to cefoperazone-tazobactam (96% vs. 89%) were observed for Escherichia coli. Similarly higher rates of susceptibility to cefoperazone-tazobactam were observed for Klebsiella as compared to cefoperazone-sulbactam (83% vs. 67%). Serratia marcescens was sensitive to cefoperazone-tazobactam but was intermediate resistant to cefoperazone-sulbactam. The isolates of Klebsiella pneumoniae that were resistant to cefoperazone-sulbactam were susceptible to cefoperazone-tazobactam.
  
  
  CONCLUSIONS
  The results of the current in vitro study corroborate the efficacy of the beta lactamase inhibitor tazobactam in improving the spectrum of activity and efficacy of cefoperazone.
authors.affiliation: Department of Pharmacology, Dr. D.Y Patil Medical College, Navi Mumbai, India.
authors.forename: Manjusha
authors.initials: M
authors.lastname: Patankar
authors.forename: Sangita
authors.initials: S
authors.lastname: Sukumaran
authors.forename: Anita
authors.initials: A
authors.lastname: Chhibba
authors.forename: Usha
authors.initials: U
authors.lastname: Nayak
authors.forename: Loraine
authors.initials: L
authors.lastname: Sequeira
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D002438:Cefoperazone / Q000627:therapeutic use*; D018550:Cephalosporin Resistance; D052978:Disk Diffusion Antimicrobial Tests; D004338:Drug Combinations; D006801:Humans; D007194:India; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D013407:Sulbactam / Q000627:therapeutic use*; D000078142:Tazobactam; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D065093:beta-Lactamase Inhibitors
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D065093:beta-Lactamase Inhibitors; D002438:Cefoperazone; D010397:Penicillanic Acid; D013407:Sulbactam; D000078142:Tazobactam