Antibacterial activity of carumonam and cefpirome on hospital strains resistant to gentamicin and cephalothin: comparison with other beta-lactam antibiotics, new fluoroquinolones, aminoglycosides and other antibiotics

The antibacterial in vitro activity of carumonam, a new monobactam, and cefpirome, a new cephalosporin, was studied on 483 hospital strains resistant to gentamicin and cephalothin, in comparison with amikacin, azlocillin, aztreonam, cefmenoxim, cefoperazone, cefotaxim, cefsulodin (for Pseudomonas), ceftazidime, ceftriaxone, cefuroxim, chloramphenicol, ciprofloxacin, doxycycline, enoxacin, netilmicin, norfloxacin, pefloxacin, piperacillin, rifampicin, tobramycin and trimethoprim. In general the two compounds have a very good in vito activity on Enterobacteriaceae but are less active on non-fermenting microorganisms. For the Enterobacteriaceae the minimal inhibitory concentrations 90% for carumonam was less than or equal to 1.1 mg/l excepted for Enterobacter spp. (43,6 mg/l) and M. morganii (56.8 mg/l) . All the Enterobacteriaceae are susceptible to cefpirome (minimal inhibitory concentrations 90% less than or equal to 5.3 mg/l). The activity of carumonam and cefpirome on Enterobacteriaceae is comparable with that of the third generation cephalosporins. Carumonam is more active than cefpirome and other beta-lactams, ceftazidime excepted, on Pseudomonas aeruginosa and Pseudomonas spp. On the other hand, both compounds reveal to have only a low activity on the other non-fermenters which minimal inhibitory concentrations 90% values of 115.4 mg/l for carumonam and 32.0 mg/l for cefpirome.     

The anti-microbial activity, beta-lactamase stability, and disk diffusion susceptibility testing of carumonam (RO 17-2301, AMA-1080), a new monobactam

Carumonam, a new monobactam, was found to have an anti-microbial spectrum similar to aztreonam. Its spectrum includes Enterobacteriaceae, Haemophilus influenzae, pathogenic Neisseria species, Pseudomonas aeruginosa, and some streptococci. Staphylococcus species, enterococci, and many other nonenteric gram-negative bacilli were not inhibited. Enterobacteriaceae resistant to cefoperazone (minimum inhibitory concentrations [MICs] greater than or equal to 32 mg/L) were more likely inhibited by carumonam (52% at less than or equal to 8.0 mg/L) than aztreonam (39%) or ceftazidime (35%). Dilution test methods on agar or in Mueller-Hinton broth produced similar results. Carumonam minimum bactericidal concentrations were usually the same or one dilution above the MIC. Carumonam and aztreonam were very stable to most chromosomal (P99, K1, K14) and plasmid-mediated beta-lactamases (TEM, OXA, PSE). The Klebsiella oxytoca enzymes hydrolyzed aztreonam at rates greater than or equal to fivefold higher than carumonam but at a rate less than 1% that of cephaloridine. The aztreonam MICs for these Klebsiella stains were greater than or equal to 32 mg/L, but the hydrolysis rates do not fully explain the high-grade resistance to aztreonam. In vitro susceptibility tests with 30-micrograms carumonam disks were found to be very predictive. Similar regression statistics were observed for aztreonam and cefotaxime. Recommendations for carumonam susceptibility testing are susceptible greater than or equal to 21 mm (less than or equal to 8.0 mg/L) and resistant less than or equal to 14 mm (greater than or equal to 32 mg/L). Cross-resistance analysis favors the independent testing of carumonam or aztreonam against gram-negative species other than Enterobacteriaceae and P. aeruginosa.     

Comparative in vitro activity of 2 monobactams (RO 172301 (AMA 1080)and aztreonam), ceftazidime and cefotaxime on Gram-negative bacilli

In vitro activities of two monobactams (RO 172301 and aztreonam), ceftazidime and cefotaxime against 739 bacterial strains belonging to different species of Gram negative aero-anaerobic bacilli were studied comparatively. Strains were studied according to their resistance phenotype to beta-lactams. Minimal inhibitory concentrations (MIC) of the four antibiotics were determined using the agar dilution method. RO 172301 and aztreonam exhibited a similar activity against P. aeruginosa with a MIC around 2 mg/l for 50% of strains and around 4 mg/l for 90% of strains. As compared to the two monobactams, ceftazidime was more active and cefotaxime less active (one halving dilution either way). Activity of antibiotics was not dependent upon the mechanism of resistance to beta-lactams, except for strains producing a constitutive cephalosporinase. Against Enterobacteriaceae, RO 172301 proved slightly more active than aztreonam and cefotaxime; ceftazidime was the least active drug. Only 12 of the 739 strains tested (1.6%) had a MIC for RO 172301 above 32 mg/l. The percentage of resistant strains was 2.4% for aztreonam and ceftazidime and 8.8% for cefotaxime.     

Pseudomonas aeruginosa: acquired in vitro resistance to beta-lactams

The development of resistance acquired in vitro to 5 semi-synthetic penicillins: carbenicillin, ticarcillin, azlocillin, mezlocillin, piperacillin and to 5 cephalosporins: cefotaxime, cefoperazone, moxalactam, cefsulodin and ceftazidime, was compared in 6 strains of Pseudomonas aeruginosa. The strains were selected on the basis of their phenotypic resistance: 3 were susceptible to all the betalactam antibiotics tested, 1 was resistant to carbenicillin and ticarcillin but remained susceptible to the others, 2 were susceptible to cefsulodin and ceftazidime but resistant to the others. The development of resistance was investigated by subsequent passages in liquid medium: up to 15 passages or up to an MIC of 4 096 mg/l for a penicillin or 512 mg/l for the cephalosporins. Irrespectively of the phenotypic resistance, for all cephalosorins the MIC became greater than or equal to 64 mg/l and very often greater than or equal to 512 mg/l after 1 to 3 passages. For the penicillin susceptible strains very high MICs were obtained more rapidly with azlocillin and piperacillin (1-2 passages) than with carbenicillin or ticarcillin (5-9 passages). These results are not in favour of a monotherapy with betalactam antibiotics, especially cephalosporins, in the treatment of Pseudomonas aeruginosa infections, but suggest the preferential use of carbenicillin and especially ticarcillin for sensitive isolates.     

In vitro activity of cefmenoxime (SCE 1365) against 616 hospital strains of gram-negative bacilli chosen for beta-lactam resistance. Comparison with cefotaxime, lamoxactam and ceftazidime

The in vitro activity of a new cephalosporin, cefmenoxime, was tested by an agar dilution procedure against 616 strains of Gram negative rods resistant to various beta-lactams and was compared with that of cefotaxime, lamoxactam, ceftazidime (and cefsulodin against P. aeruginosa). A high activity was demonstrated on many species of tested Enterobacteriaceae including E. coli, K. pneumoniae, S. marcescens, E. cloacae resistant to the first generation cephalosporins, Proteus sp., Providencia and C. freundii, with MIC geometric mean values from 0,028 to 0,33 microgram by ml. These values were nearly similar to those given by cefotaxime or lamoxactam and inferior to those given by ceftazidime. Cefmenoxime however showed a low activity (MIC geometric means from 19,5 to 25,5 micrograms by ml) against E. cloacae resistant to second generation cephalosporins (the better agent was lamoxactam), A. calcoaceticus (the better agent was ceftazidime) and carbenicillin-resistant P. aeruginosa (here ceftazidime and cefsulodin gave better performances).     

In vitro sensitivity at 18 antibiotics of 192 strains of Pseudomonas aeruginosa isolated at Garches Hospital

The in vitro activity of 18 antibiotic (beta-lactam agents, quinolones and aminoglycoside has been evaluated against 192 clinical isolates of Pseudomonas aeruginosa. Minimal inhibitor concentrations (MICs) were determined by the agar dilution technique. The 50% and 90% MICs were respectively: ticarcillin (32/greater than 1 024), azlocillin (16/512), piperacillin (8/512), cefsulodin (4/128), ceftazidime (2/8), aztreonam (4/16), imipenem (2/4), nalidixic acid (128/256), pefloxacin (1/8), norfloxacin (1/8), ofloxacin (2/8), ciprofloxacin (0.25/2), gentamicin (8/256), sisomicin (4/256), tobramycin (2/128) dibekacin (4/256), netilmicin (16/256), amikacin (8/16). The sensitivity to beta-lactam agents and to quinolones was usual. Resistance to aminoglycosides was frequently observed (59%): 35.7% of the resistant isolates were resistant to gentamicin-sisomicin-tobramycin-dibekacin-netilmicin, 30% to netilmicin alone, 17.8% to gentamicin-sisomicin-tobramycin-dibekacin-netilmicin-amikacin, 7% to gentamicin-netilmicin, 5.3% to gentamicin-sisomicin-tobramycin-dibekacin; we did not find any P. aeruginosa resistant only to gentamicin or gentamicin-sisomicin.     

Sensitivity of Pseudomonas aeruginosa to beta-lactam antibiotics. Apropos of 338 strains isolated at the Regional Hospital Center at Nantes in 1984

The MIC of 338 Pseudomonas aeruginosa strains isolated in 1984, in a French hospital, was determined by an agar dilution method, using seven beta-lactam antibiotics: ticarcillin, azlocillin, piperacillin, cefoperazone, ceftriaxone, cefsulodin and ceftazidime. The MIC50-MIC90 were respectively: 32-64, 8-32, 8-16, 8-16, 16-64, 4-16, 2-4 mg/l. Ticarcillin was the most frequently effective compound (95% of the strains were susceptible), 90% of the strains were susceptible to ceftazidime or piperacillin, 87% to azlocillin and 84% to cefsulodin. Cefoperazone and ceftriaxone were much less effective (43% and 19% of the strains, respectively). The study of the resistance patterns showed a higher percentage (80%) of strains susceptible to all the penicillins than the percentage of strains susceptible to cephalosporins, most of them however were susceptible to both cefsulodin and ceftazidime. It also showed the relatively low frequency of resistant strains by inducible cephalosporinase or decreased permeability. Serovar 0.12 was characterized by its multi-resistance to beta-lactam antibiotics.     

Comparison of in vitro bacteriostatic effect of five betalactamins against Pseudomonas aeruginosa (author's transl)

In vitro activity of two penicillins (ticarcillin and azlocillin) and three cephalosporins (cefoperazone, cefsulodin and ceftazidime) was compared against one hundred clinical isolates of Pseudomonas aeruginosa originated in two different Paris hospitals. Twenty strains were resistant to carbenicillin at a concentration of 128 mg/l. Minimal inhibitory concentrations (MICs) were determined by a twofold agar dilution method. The required ceftazidime concentration to inhibit 90 p. cent of the carbenicillin-susceptible isolates was 1,9 mg/l. To achieve the same inhibition, 3,9 mg of cefsulodin, 12 mg of cefoperazone, 14 mg of azlocillin or 38 mg of ticarcillin per liter were needed. Against the 209 carbenicillin-resistant isolates, ceftazidime remained active at concentrations lower than 2 mg/l in 90 p. cent of the cases. To obtain such an inhibition with the other antibiotics higher concentrations were needed.     

Correlation between sensitivity to fosfomycin and the presence of penicillinase PSE-1 in Pseudomonas aeruginosa

A prospective survey was carried out during three three-weeks periods in May, October 1997 and October 1998 in 13 teaching hospitals. All non-repetitive isolates of P. aeruginosa collected were subject to serotypage and determination of the inhibiting minimal concentrations for ticarcillin, piperacillin, piperacillin + tazobactam, ceftazidime, imipenem, amikacin, ciprofloxacin and fosfomycin. Identification of the betalactamases and quantification of the cephalosporinase were done for the strains intermediate or resistant to ticarcillin. The most frequent serotypes were O: 6 (17%), O: 11 (13%), O: 1 (10%) and O: 12 (9%). Serotype O: 12 was the least susceptible to antibiotics except for fosfomycin. Whatever the serotype, 76% of P. aeruginosa strains with bla PSE-1 are susceptible to fosfomycin, when only 29.8% of non bla PSE-1 producing strains were susceptible to this antibiotic. Integron encoding bla PSE-1 could be implicated in susceptibility to fosfomycin of P. aeruginosa strains. The associations fosfomycin + imipenem or fosfomycin + ceftazidime could be proposed in case of infections due to P. aeruginosa O: 12.     

In vitro antibacterial activity of cefodizime (HR 221) on 323 hospital strains of Gram negative bacilli. Comparison with cefotiam, cefoperazone, cefotetan and cefotaxime

In vitro activity of a new cephalosporin, cefodizime, was investigated by comparison with cefotiam, cefoperazone, cefotetan and cefotaxime. 291 Enterobacteriaceae strains belonging to 6 cephalosporin-resistance phenotypes and 32 strains of oxidative Gram negative bacilli were tested. With modal MICs of 0.25 to 4 mg/l, cefodizime is active on most phenotypes of resistance to first or second generation cephalosporins demonstrated in vitro in Enterobacteriaceae, including strains resistant to cefamandole and intermediate to cefoxitin. Cefodizime fails to inhibit strains resistant to third generation cephalosporins (E. cloacae, C. freundii, P. stuartii), except for those strains of S. marcescens belonging to this phenotype whose modal MIC is 4 mg/l. 85% of all tested Enterobacteriaceae are inhibited by 4 mg/l and 91% by 8 mg/l. Cefodizime exhibits little activity against A. calcoaceticus and P. aeruginosa. Comparison of activities of the five cephalosporins against Enterobacteriaceae shows that cefodizime out-strips cefotiam, cefoperazone and cefotetan as a result of its broader spectrum of activity against tested species. Cefotaxime, on the contrary, proves superior to cefodizime and is still the most potent drug against. A. calcoaceticus whereas cefoperazone has the greatest effectiveness against P. aeruginosa.     

Susceptibility of extended-spectrum-beta-lactamase-producing Enterobacteriaceae according to the new CLSI breakpoints

In 2010 the Clinical and Laboratory Standards Institute (CLSI) lowered the susceptibility breakpoints of some cephalosporins and aztreonam for Enterobacteriaceae and eliminated the need to perform screening for extended-spectrum β-lactamases (ESBLs) and confirmatory tests. The aim of this study was to determine how many ESBL-producing strains of three common species of Enterobacteriaceae test susceptible using the new breakpoints. As determined with the CLSI screening and confirmatory tests, 382 consecutive ESBL-producing strains were collected at Huashan Hospital between 2007 and 2008, including 158 strains of Escherichia coli, 164 of Klebsiella pneumoniae, and 60 of Proteus mirabilis. Susceptibility was determined by the CLSI agar dilution method. CTX-M-, TEM-, and SHV-specific genes were determined by PCR amplification and sequencing. bla(CTX-M) genes alone or in combination with bla(SHV) were present in 92.7% (354/382) of these ESBL-producing strains. Forty-two (25.6%) strains of K. pneumoniae harbored SHV-type ESBLs alone or in combination. No TEM ESBLs were found. Utilizing the new breakpoints, all 382 strains were resistant to cefazolin, cefotaxime, and ceftriaxone, while 85.0 to 96.7% of P. mirabilis strains tested susceptible to ceftazidime, cefepime, and aztreonam, 41.8 to 45.6% of E. coli strains appeared to be susceptible to ceftazidime and cefepime, and 20.1% of K. pneumoniae were susceptible to cefepime. In conclusion, all ESBL-producing strains of Enterobacteriaceae would be reported to be resistant to cefazolin, cefotaxime, and ceftriaxone by using the new CLSI breakpoints, but a substantial number of ESBL-containing P. mirabilis and E. coli strains would be reported to be susceptible to ceftazidime, cefepime, and aztreonam, which is likely due to the high prevalence of CTX-M type ESBLs.     

Comparative activities of 15 beta-lactam antibiotics against 590 strains of Klebsiella pneumoniae according to the production of beta-lactamase

In October 1988, all non repetitive strains of K. pneumoniae isolated in 17 hospitals have been studied. Among these 590 strains: 451 (76%) only produce the specific beta-lactamase of the species SHV-1 (pI 7,7) or SHV-1 type (pI 7,1), while 74 (12.5%) produce a TEM-1 or TEM-2 type beta-lactamase, and 65 (11%) an extended broad spectrum beta-lactamase: 22 CTX-1, 5 SHV-2, 4 SHV-3, 26 SHV-4, 8 SHV-5. The minimum inhibitory concentrations of the following antibiotics were performed by a liquid micro dilution technic: amoxicillin (AMX), amoxicillin + clavulanic acid (CL), 5 mg/l, ticarcillin (TIC), piperacillin (PIP), cefazolin (CEZ), cefamandole (CFM), cefoperazone (CFP), cefotaxime (CTX), cefotaxime + clavulanic acid 5 mg/l, cefotaxime + sulbactam (SUL) 5 mg/l, cefpirome (CPI), ceftazidime (CAZ), azthreonam (AZT), latamoxef (MOX), cefoxitin (FOX), cefotetan (CTT), temocillin (TMO), imipenem (IMI). The "wild" strains with SHV-1 beta-lactamase are resistant to AMX and have a decreased susceptibility to TIC and PIP, but are susceptible to other antibiotics. The TEM producing strains are more resistant to PIP and TIC, have a decreased susceptibility to CEZ and CFM but are susceptible to other antibiotics. For the extended broad-spectrum beta-lactamase producing strains, the MIC of penicillin antibiotics (AMX, TIC, PIP) are very high and also the MIC of CEZ, CFM and CFP. The MIC of CTX are higher for CTX-1 or SHV-4 producing strains, than for SHV-2, SHV-3, or SHV-5 producing strains. The combination with CL is more efficacious than the one with SUL to reduce the MIC of CTX in susceptibility area.(ABSTRACT TRUNCATED AT 250 WORDS)     

Changes in resistance of Pseudomonas aeruginosa to beta-lactams in a general intensive care unit over a three-year period. Role of piperacillin

Nosocomial infections by Pseudomonas aeruginosa seen in a general intensive care unit from January 1987 through December 1989 were studied. Use of piperacillin, ticarcillin, cefsulodine, ceftazidime, and imipenem over the same period were recorded. Rate of infection by P. aeruginosa among the 1,844 patients admitted during the study period was 3.2%; 32% of all nosocomial infections during this period were due to P. aeruginosa. The proportion of P. aeruginosa strains exhibiting in vitro susceptibility to ticarcillin rose from 45.5% in 1987 to 59% in 1988 and 86% in 1989. Concomitantly, the proportion of P. aeruginosa strains simultaneously resistant to ticarcillin, piperacillin, cefsulodine and ceftazidime fell from 32% to 18.5% then 0%. A statistically significant correlation was found between the decrease in piperacillin use and the fall in penicillinase-producing ticarcillin-resistant strains of P. aeruginosa. Because piperacillin has undesirable effects on the intestinal flora and promotes the emergence of resistant strains of P. aeruginosa, the authors now use narrow spectrum antimicrobial agents as first line treatment of nocosomial infections.     

Sensitivity of Pseudomonas aeruginosa to beta-lactam antibiotics and effects of beta-lactamases

The activities of carbenicillin, ticarcillin, piperacillin, cefsulodin, ceftriaxone, azlocillin, ceftazidime and apalcillin were evaluated against 128 hospital isolates of Pseudomonas aeruginosa. Against the 85 isolates that were susceptible to carbenicillin, apalcillin had the best minimal inhibitory concentrations, the median MIC being 1, 1 microgram/ml. Against the 43 isolates resistant to carbenicillin, ceftazidime inhibited 90% of organisms at a concentration of 16 micrograms/ml. A constitutive beta-lactamase, was found in 27 of the 43 resistant isolates. All the 128 isolates, but one, were producers of an inducers of an inducible beta-lactamase. Ceftriaxone, piperacillin and azlocillin were highly antagonized by cefoxitin. The extent of antagonism was lower with ticarcillin and carbenicillin.     

396株嗜麦芽窄食单胞菌的耐药特征研究

目的研究嗜麦芽窄食单胞菌的耐药特征。方法采用美国临床实验室标准化委员会（ＮＣＣＬＳ）推荐的纸片扩散法,测定了５年中初次分离的３９６株嗜麦芽窄食单胞菌对ＴＭＰ－ＳＭＺ,多西环素,替卡西林－克拉维酸等２０种抗生素的耐药特征,并对１０例嗜麦芽窄食单胞菌菌血症的治疗进行了分析。结果嗜麦芽窄食单胞菌对ＴＭＰ－ＳＭＺ,替卡西林－克拉维酸,多西环素,环丙沙星和头孢他啶的敏感率最高,分别为８１．０％,９１．０％,９６．０％,７０．７％和５３．８％,而对氨苄西林,氨苄西林－舒巴坦,阿莫西林－克拉维酸,头孢唑林,头孢克罗,头孢美唑,头孢呋辛,头孢噻肟,头孢曲松,氨曲南,亚胺培南高水平耐药,敏感率为（０．９～７．５）％。从替卡西林－克拉维酸,多西环素,ＴＭＰ－ＳＭＺ,环丙沙星和头孢他啶对嗜麦芽窄食单胞菌抑菌环直径分布累积百分率图看出：替卡西林－克拉维酸,多西环素,ＴＭＰ－ＳＭＺ和环丙沙星为活性最好的抗生素。结论替卡西林－克拉维酸,ＴＭＰ－ＳＭＺ和多西环素对所研究的嗜麦芽窄食单胞菌有较高的活性,系嗜麦芽窄食单胞菌菌血症严重感染治疗最有效的抗生素     

Evaluation of the VITEK 2 system for the identification and susceptibility testing of three species of nonfermenting gram-negative rods frequently isolated from clinical samples

VITEK 2 is a new automatic system for the identification and susceptibility testing of the most clinically important bacteria. In the present study 198 clinical isolates, including Pseudomonas aeruginosa (n = 146), Acinetobacter baumannii (n = 25), and Stenotrophomonas maltophilia (n = 27) were evaluated. Reference susceptibility testing of cefepime, cefotaxime, ceftazidime, ciprofloxacin, gentamicin, imipenem, meropenem, piperacillin, tobramycin, levofloxacin (only for P. aeruginosa), co-trimoxazole (only for S. maltophilia), and ampicillin-sulbactam and tetracycline (only for A. baumannii) was performed by microdilution (NCCLS guidelines). The VITEK 2 system correctly identified 91.6, 100, and 76% of P. aeruginosa, S. maltophilia, and A. baumannii isolates, respectively, within 3 h. The respective percentages of essential agreement (to within 1 twofold dilution) for P. aeruginosa and A. baumannii were 89.0 and 88.0% (cefepime), 91.1 and 100% (cefotaxime), 95.2 and 96.0% (ceftazidime), 98.6 and 100% (ciprofloxacin), 88.4 and 100% (gentamicin), 87.0 and 92.0% (imipenem), 85.0 and 88.0% (meropenem), 84.2 and 96.0% (piperacillin), and 97.3 and 80% (tobramycin). The essential agreement for levofloxacin against P. aeruginosa was 86.3%. The percentages of essential agreement for ampicillin-sulbactam and tetracycline against A. baumannii were 88.0 and 100%, respectively. Very major errors for P. aeruginosa (resistant by the reference method, susceptible with the VITEK 2 system [resistant to susceptible]) were noted for cefepime (0.7%), cefotaxime (0.7%), gentamicin (0.7%), imipenem (1.4%), levofloxacin (2.7%), and piperacillin (2.7%) and, for one strain of A. baumannii, for imipenem. Major errors (susceptible to resistant) were noted only for P. aeruginosa and cefepime (2.0%), ceftazidime (0.7%), and piperacillin (3.4%). Minor errors ranged from 0.0% for piperacillin to 22.6% for cefotaxime against P. aeruginosa and from 0.0% for piperacillin and ciprofloxacin to 20.0% for cefepime against A. baumannii. The VITEK 2 system provided co-trimoxazole MICs only for S. maltophilia; no very major or major errors were obtained for co-trimoxazole against this species. It is concluded that the VITEK 2 system allows the rapid identification of S. maltophilia and most P. aeruginosa and A. baumannii isolates. The VITEK 2 system can perform reliable susceptibility testing of many of the antimicrobial agents used against P. aeruginosa and A. baumannii. It would be desirable if new versions of the VITEK 2 software were able to determine MICs and the corresponding clinical categories of agents active against S. maltophilia.     

Application of a millipore membrane transfer method to the study of the activity of 4 beta-lactams on Pseudomonas aeruginosa

In vitro activities of four cephalosporins, i.e. cefoperazone, cefsulodin, ceftazidime and CM 40874, on 31 ticarcillin-susceptible or resistant Pseudomonas aeruginosa strains were compared. Minimal inhibitory and bactericidal concentrations were determined by the conventional broth technique and by a filter membrane transfer method on agar. MICs determined by both methods were comparable for each strain. Some discrepancies were found for minimal bactericidal concentrations. Among the cephalosporins studied on ticarcillin-susceptible Pseudomonas aeruginosa strains, the most active was ceftazidime, followed by cefsulodin, CM 40874 and cefoperazone. Resistance of Pseudomonas aeruginosa to ticarcillin was associated with an overall increase in resistance to the four cephalosporins studied. These cephalosporins can be classified according to bacteriostatic and bactericidal effect in the following decreasing order: ceftazidime, CM 40874, cefsulodin and cefoperazone.     

Evaluation of the VITEK 2 cards for identification and antimicrobial susceptibility testing of non‐glucose‐fermenting Gram‐negative bacilli

We evaluated VITEK 2 cards (NGNC and AST‐GN10) for the accuracy of identification (ID) and antimicrobial susceptibility testing (AST) of non‐glucose‐fermenting Gram‐negative bacilli (NGF‐GNB). In a total of 201 strains, 190 strains (94.5%) were correctly identified, seven strains (3.5%) showed low discrimination, four strains (2.0%) had discrepancies, and no strain remained unidentified. Reference AST of amikacin, aztreonam, cefepime, cefotaxime, ceftazidime, ciprofloxacin, imipenem, levofloxacin, piperacillin‐tazobactam, and trimethoprim‐sulfamethoxazole was performed by the agar dilution method. Approximately 82.5% of ID and 72.9% of AST were completed within 7 and 14 h, respectively. For NGF‐GNB, other than Pseudomonas aeruginosa, Acinetobacter spp., Stenotrophomonas maltophilia, and the Burkholderia cepacia group, essential agreements (EAs) were 93.6–100.0%. Severe disagreements (resistant by the reference method to susceptible by AST‐GN10) were observed for amikacin (0.9%), cefepime (1.8%), cefotaxime (1.8%), imipenem (0.9%), and piperacillin‐tazobactam (0.9%). One major disagreement (susceptible to resistant) was observed for ceftazidime (0.1%). For P. aeruginosa, EAs were 85.7–100%, with severe disagreements observed for cefepime (4.8%) and piperacillin‐tazobactam (4.8%). For Acinetobacter spp., EAs were 86.4–100% without disagreements. The VITEK 2 cards appear to be promising for rapid ID and reliable AST for most species of NGF‐GNB.     

Choice of a rapidly bactericidal beta-lactamin-aminoglycoside combination in the treatment of Pseudomonas aeruginosa infections at a child intensive care unit

Morbidity and mortality among children with Pseudomonas aeruginosa infection in Pediatric Intensive Care Unit remains high. Delays in bacterial killing may be responsible for the poor outcome. Antimicrobial sensitivity and timed-killing assays were determined for ticarcillin, azlocillin, piperacillin, cefsulodin, ceftazidime, gentamicin, tobramycin and amikacin alone and in combination against 40 strains of Pseudomonas aeruginosa isolated from blood cultures and tracheal aspirate. Antibiotic concentrations used were at clinically achievable level. None bactericidal effect was observed with each beta-lactamin alone. However with the combinations azlocillin or piperacillin or cefsulodin or ceftazidime plus amikacin a bactericidal effect was observed at 4.5 hours.     

In-vitro activity of ceftriaxone on Gram-negative bacilli with various resistance phenotypes to cephalosporins. Comparison with cefotaxime, cefmenoxime, moxalactam, ceftazidime

In vitro activity of ceftriaxone was studied on 245 cephalothin-resistant strains of enterobacteria representing 7 different phenotypes of resistance to cephalosporins and on 130 Gram negative oxidative bacilli. Ceftriaxone was compared to cefotaxime, cefmenoxime, moxalactam and ceftazidime. With modal MICs of 0.015 to 0.25 mg/l, ceftriaxone is active on all phenotypes of enterobacteria not simultaneously resistant to cefamandole and cefoxitin. Among the bacteria with this last phenotype, only K. pneumoniae, C. Freundii and E. cloacae are occasionally found to have intermediate susceptibility or even resistance; ceftriaxone is more active than cefotaxime, cefmenoxime and ceftazidime with inhibition of 95.1% of strains at 4 mg/l. Moxalactam is superior to ceftriaxone against enterobacteria that are intermediate or resistant to both cefamandole and cefoxitin. Activity of ceftazidime is strongest against oxidative bacilli and weakest against enterobacteria regardless of phenotype.