What does the susceptible-dose dependent interpretive category for cefepime in ESBL-producing bacteria?

Abstract

In this study, we investigated the frequency of isolates included in the susceptible-dose dependent (SDD) category, according to the Clinical and Laboratory Standards Institute guidelines, carrying bla_TEM, bla_SHV and bla_CTX genes among 92 Klebsiella pneumoniae and 80 Enterobacter cloacae clinical isolates. The presence of one or more extended-spectrum β-lactamases (ESBLs) genes was observed in 64% K. pneumoniae and 69% E. cloacae isolates. Nineteen isolates were included in SDD interpretive category criteria, of which 15 carried ESBL genes (seven K. pneumoniae and eight E. cloacae). Considering the high proportion of ESBL gene-containing isolates included in the SDD category (79%), we recommend that physicians exercise caution in the use of cefepime for treatment of infections caused by these isolates, reducing possible therapeutic failure, particularly in cases of ESBL-producing bacterial strains.

Keywords:

• Cefepime
• Minimum inhibitory concentration
• Susceptible-dose dependent
• Extended-spectrum β-lactamase
• Klebsiella pneumoniae
• Enterobacter cloacae

Acknowledgements

We thank James Young for English text review.

Potential conflict of interests

All authors report no conflict of interests relevant to this article.

Funding

This work was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) (funding in the form of post graduation scholarship) and Fundação Araucária [grant number 179-10 UEM/Fundação Araucária].