Abstract
BackgroundTo investigate a possible role of Cefditoren, a recently marketed in Greece third-generation oral cephalosporin in urinary infections of outpatients.MethodsDuring a multicenter survey of Enterobacteriaceae causing UTIs in outpatients during 2005–2007, Cefditoren MICs were determined by agar dilution method in a randomly selected sample of uropathogens. Susceptibility against 18 other oral/parenteral antimicrobials was determined according to Clinical and Laboratory Standards Institute methodology.ResultsA total of 563 isolates (330 Escherichia coli, 142 Proteus mirabilis and 91 Klebsiella spp) was studied; MIC50/MIC90 of Cefditoren was 0.25/0.5 mg/L respectively, with 97.1% of the isolates being inhibited at 1 mg/L. All 12 strains producing ESBLs or AmpC enzymes were resistant to cefditoren. Susceptibility rates (%) for amoxicillin/clavulanic acid, cefuroxime axetil, cefotaxime, ciprofloxacin, trimethoprim/sulfamethoxazole and fosfomycin were 93.1- 94.1- 96.8-93.1-71.9 and 92.8% respectively. Cefditoren MIC was significantly higher in nalidixic/ciprofloxacin non-susceptible strains; resistance to cefditoren was not associated with resistance to mecillinam, fosfomycin nitrofurantoin and aminoglycosides. Multivariate analysis demonstrated history of urinary infection in the last two weeks or three months as risk factors for cefditoren resistance.ConclusionsCefditoren exhibited enhanced in vitro activity against the most common uropathogens in the outpatient setting, representing an alternative oral treatment option in patients with risk factors for resistance to first-line antibiotics.
Highlights
To investigate a possible role of Cefditoren, a recently marketed in Greece third-generation oral cephalosporin in urinary infections of outpatients
Demographic analysis Cefditoren was studied against a total of 563 isolates (330 E. coli, 142 Proteus mirabilis and 91 Klebsiella spp-three K. oxytoca and 88 K. pneumoniae)
Evaluable clinical information was available for 334/563 isolates (59.3%), i.e. 214/330 E. coli (64.8%), 75/142 P. mirabilis (52.8%) and 45/91 Klebsiella spp (49.5%)
Summary
To investigate a possible role of Cefditoren, a recently marketed in Greece third-generation oral cephalosporin in urinary infections of outpatients. Urinary tract infections (UTIs) represent the most frequent bacterial infection encountered in the community setting being caused in their vast majority by members of the family of Enterobacteriaceae [1,2]. Antimicrobial resistance among uropathogens causing uncomplicated cystitis has increased, as well as the recognition of the importance of the ecological adverse is true for purely “community” infections and nosocomial or healthcare-associated infections that are being treated in the community [3,6]. Cefditoren is a third generation oral cephalosporin with a broad spectrum of activity comprising Gram-positive and Gram-negative bacterial species [7,8]. Against ESBL-producing strains, no sustained bactericidal activity was demonstrated: against strains harboring the SHV determinant bactericidal activity was achieved only in the 6- to 8-h whereas against the TEM-116 strain a 2-log regrowth occurred from 12 to 24 h [9]
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