Cefepime/tazobactam as a new treatment option for multidrug resistant gram negative bacilli
Keywords:Cefepime/Tazobactam, Carbapenems, β-Lactam/β-Lactamase inhibitors
Background: Every time an antibiotic is used, whether appropriately or not, the probability of the development and spread of antibiotic resistant bacteria is increased. Thus, multidrug resistant bacteria particularly ESBL (Extended spectrum βlactamase), Amp C and carbapenemases producing gram negative bacilli have emerged as a major health problem all over the world. Considering new treatment options as a carbapenems sparing and resistance prevention modality, this study was aimed to know the in vitro susceptibility pattern of Cefepime/Tazobactam (CPM/TZ) in comparison to other β-Lactam/ β-Lactamase inhibitors (BL/BLI) and carbapenems against GNB.
Methods: A prospective study was conducted on all clinical samples received for a period of about 1 year. Identification and susceptibility of all isolates was done by Vitek 2 Compact system. Susceptibility of CPM/ TZ was done by disc diffusion method on the basis of CLSI guidelines. Both fermenters (E. coli and Klebsiella pneumoniae) and non-fermenters (Acintobacter baumanii and Pseudomonas aeruginosa) were included in the study.
Results: Out of 550 GNB isolates the most common was E. coli (61.8%), Acintobacter baumanii (16%), Klebsiella pneumoniae (14.9%) and Pseudomonas aeruginosa (7.3%). Cefepime/tazobactam had a much higher susceptibility of 68% compared to cefepime (28%). Among the BL/BLI combinations tested cefepime/tazobactam (68%) showed the maximum percentage of susceptibility followed by cefoperazone/sulbactam (61.5%) and piperacillin/tazobactam (57.6%). Amongst all GNB isolates cefepime/tazobactam (68%) sensitivity was very much comparable to imipenem (71.8%) and meropenem (69.6%).
Conclusions: CPM/TZ exhibited the best in vitro activity in comparison to the other BL/BLI. This new combination of cefepime/tazobactam appears to be a promising alternative therapeutic option to carbapenems. Clinical studies are needed to confirm this in vitro study result.
Group GARP-IW. Rationalizing antibiotic use to limit antibiotic resistance in India. Indian J Med Res. 2011;134(3):281.
Mudshingkar SS, Dedwal AK, Palewar MS, Dohe VB, Kagal AS, Bhardwaj RS. Cefepime/ tazobactam-a promising BL-BLI combination against multidrug resistant Gram-negative bacteria. Int J Healthcare Biomed Res. 2014;2(3):127-8.
Ghafur A, Pushparaju R, Nalini S, Rajkumar K, Sureshkumar D. Sensitivity pattern of Gram-negative bacteria to the new β-lactam/β-lactamase inhibitor combination: cefepime/tazobactam. J Microbiol Inf Dis. 2012;2(1):5-8.
Collee JG, Miles RS, Wan B. Tests for the identification of bacteria. In: Mackie and McCartney Practical Medical Microbiology. 14th ed. Churchill Livingstone; 1996:131-150.
Specimen management. In: Forbes BA, Sahm DF, Weissfeld AS, eds. Bailey and Scott’s Diagnostic Microbiology. 12th ed. Elsvier; 2007:62-77.
Culturing Bacterial Pathogens. In: Cheesbrough M. District Laboratory Practice in Tropical Countries Part 2. 2nd ed: Press Syndicate of the University of Cambridge; 2005:45-62.
Clinical Laboratory Standards Institute. Performance standards for Antimicrobial Susceptibility testing. Twenty sixth informational supplement Wayne, PA: CLSI; 2016.
Andes DR, Craig WA. Cephalosporins. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell Douglas and Bennetts' Principles and Practice of Infectious Diseases. 7th ed: Churchill Livingstone; 2010:323-336.
Sood S. Comparative evaluation of the in-vitro activity of six β-lactam/β-lactamase inhibitor combinations against gram negative bacilli. J Clin Diagn Res: JCDR. 2013;7(2):224.
Abdul K, Vidyalakshmi P, Jayalakshmi V, Poojary I. Susceptibility profile of Gram-negative bacteremic isolates to beta lactam-beta lactamase inhibitor agents in comparison to other antibiotics. Indian J Cancer. 2014;51(4):450.
Susan M, Hariharan T, Sonya J. A comparative in vitro study of Cephalosporin/Beta-lactamase inhibitor combinations against Gram negative bacilli. Ind J Physiol Pharmacol. 2013;57(4):425-31.
Sharma S, Gupta A, Arora A. Cefepime Tazobactam: A new β lactam/β lactamase inhibitor combination against ESBL producing gram negative bacilli. Int J Pharm Biomed Sci. 2012;2:35-8.
Prakash S. Carbapenem sensitivity profile amongst bacterial isolates from clinical specimens in Kanpur city. Ind J Crit Care Med. 2006;10(4):250.