In vitro activity of ertapenem and other carbapenems against extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae clinical isolates in a tertiary care center in Turkey


Kiremitci A., DİNLEYİCİ E. Ç. , ERBEN N., DURMAZ G., Yargic Z. A. , Aybey A. D. , ...More

EXPERT OPINION ON PHARMACOTHERAPY, vol.9, no.9, pp.1441-1449, 2008 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 9 Issue: 9
  • Publication Date: 2008
  • Doi Number: 10.1517/14656566.9.9.1441
  • Journal Name: EXPERT OPINION ON PHARMACOTHERAPY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.1441-1449
  • Eskisehir Osmangazi University Affiliated: Yes

Abstract

Objective: To evaluate the in vitro effect of ertapenem, imipenem and meropenem in clinical isolates of extended-spectrum beta-lactamase (ESBL)-producing strains of Escherichia coli and Klebsiella pneumoniae. Design/methods: We studied 82 consecutive clinical isolates of ESBL-producing E. coli (n = 49) and K. pneumonia (n = 33) between February 2006 and September 2007. The minimum inhibitory concentration for each carbapenem was determined using the agar dilution method. Results: Eighty two consecutive microorganisms from sterile sites were evaluated. A total of 48.8% of patients had a history of surgical intervention, 78.0% needed urinary catheterization, 57.3% required vascular access and 40.3% mechanical ventilation; and 70.7% had a history of ICU stay. High resistance rates were shown for both E. coli and K. pneumoniae against cefepime (81.7%), ciprofloxacin (50.9%), tetracycline (75.0%), co-trimoxazole (47.4%), and gentamicin (48.7%). In addition, most K. pneumoniae and E. coli isolates were susceptible to amikacin (78.3%) and piperacilline-tazobactam (91.5%). Meropenem and imipenem showed activity against 100% of the isolates. Ertapenem showed activity against 100% of K. pneumoniae isolates, against 95.9% of E. coli isolates and against 97.5% of the 82 ESBL-producing microorganisms. Two E. coli isolates showed ertapenem resistance. Conclusion: In recent literature, carbapenems were the most active antimicrobial agents against ESBL-producing Enterobacteriaceae, as in our study. This is the first study on the in vitro activity of ertapenem against ESBL-producing E. coli and K. pneumoniae conducted in Turkey. In view of the serious infections caused by ESBL-producing microorganisms, therapeutic interventions are still problematic in serious clinical conditions. Ertapenem may be a good choice for treatment, with the additional advantage of being a once a day regimen.