title: Cefoxitin as a carbapenem-sparing antibiotic for infections caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae.
abstract: BACKGROUND
  Cefoxitin has demonstrated in vitro resistance to hydrolysis by extended-spectrum beta-lactamases.
  
  
  METHODS
  We evaluated the microbiological and clinical efficacy of cefoxitin in 33 patients treated for an infection related to extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). Clinical and microbiological outcomes were assessed from the initiation of cefoxitin therapy to the latest information available in the patient's medical file.
  
  
  RESULTS
  The 33 patients were mainly males (n = 26), aged 70 years (median, minimum-maximum: 23-93) and main sites of infection were urinary (n = 23) and catheter-related bloodstream infections (n = 4). Escherichia coli and Klebsiella pneumoniae were isolated in 19 and 14 subjects, respectively. The clinical outcome was favorable in 30 of 33 patients in the first 48 h after the start of cefoxitin, and in 20 (of 24 evaluable) at the end of follow-up. Six microbiological failures were documented and resistance to cefoxitin emerged in two strains of K. pneumoniae.
  
  
  CONCLUSIONS
  Cefoxitin could be considered as a carbapenem-sparing antibiotic for some ESBL-E infections, preferentially those related to E. coli.
authors.affiliation: From the Unité Mobile de Microbiologie Clinique, Hôpital Européen Georges Pompidou , Paris , France.
authors.forename: Solen
authors.initials: S
authors.lastname: Kernéis
authors.forename: Sandrine
authors.initials: S
authors.lastname: Valade
authors.forename: Guillaume
authors.initials: G
authors.lastname: Geri
authors.forename: Fabrice
authors.initials: F
authors.lastname: Compain
authors.forename: Marie
authors.initials: M
authors.lastname: Lavollay
authors.forename: Hidayeth
authors.initials: H
authors.lastname: Rostane
authors.forename: Etienne
authors.initials: E
authors.lastname: Carbonnelle
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Mainardi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015780:Carbapenems / Q000494:pharmacology; D002440:Cefoxitin / Q000008:administration & dosage*; D004926:Escherichia coli / Q000187:drug effects* / Q000201:enzymology / Q000502:physiology; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology / Q000502:physiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002440:Cefoxitin; D001618:beta-Lactamases
keywords: Cefoxitin; Enterobacteriaceae; extended-spectrum beta-lactamase