a contemporary understanding of β-lactam/inhibitor 881
Address correspondence to Günter Kampf, MD, University Medicine Greifswald, Institute for Hygiene and Environmental Medicine, Walter- Rathenau-Straße 49 A, 17475 Greifswald, Germany (guenter.kampf@uni-
greifswald.de). Infect Control Hosp Epidemiol 2017;38:880–881 © 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3807-0021. DOI: 10.1017/ice.2017.85
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4. Kampf G, Marschall S, Eggerstedt S, Ostermeyer C. Efficacy of ethanol-based hand foams using clinically relevant amounts: a cross-over controlled study among healthy volunteers. BMC Infect Dis 2010;10:78.
3. Macinga DR, Shumaker DJ, Werner HP, et al. The relative influences of product volume, delivery format and alcohol con- centration on dry-time and efficacy of alcohol-based hand rubs. BMC Infect Dis 2014;14:511.
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The prevalence of gram-negative bacteria resistant to broad-spectrum β-lactams has increased alarmingly in past decades, including those extended-spectrum β-lactamase (ESBL)– producing organisms with poorer clinical outcomes than more susceptible organisms.2 Unequivocally, carbapenems have a relatively high clinical
success rate among patients infected with ESBL-producing organisms.3 However, indiscriminate carbapenem use has contributed to the increased emergence of carbapenem-resistant Enterobacteriaceae (CRE).4 Because it is crucially important to conserve the usefulness of
carbapenems in the era of antimicrobial resistance, a survey was conducted to monitor the contemporary crude prevalence of resistance rates for BL/IBL combinations against Escherichia coli, Klebsiella,and Proteus species displaying a conventional or ESBL- enzyme spectrum, including those presenting a carbapenem- resistance profile but not a carbapenemase production relation. Enterobacterial isolates were recovered from inpatients between
Understanding the β-Lactam/Inhibitor of β-Lactamase Combinations: Reassessment for Better Antimicrobial Stewardship
To the Editor—The β-lactamases are plasmid-encoded or chromosomally encoded enzymes that hydrolyze β-lactam antibiotics. Those that are plasmid-mediated can be rapidly transferred between bacterial genera and can put in check the successful use of β-lactam agents. The β-lactam/inhibitor of β-lactamase (BL/IBL) combinations are a class of agents with proven success in treating infections caused by bacteria produ- cing β-lactamases, mostly the conventional-spectrum enzymes.1
isolates (93.2%) had a community profile: 441 E. coli (50.2%); 213 Proteus mirabilis (24.3%); 210 K. pneumoniae (23.9%); and 14 K. oxytoca (1.6%). In addition, 62 isolates (6.6%) had an ESBL-producing spectrum: 53 K. pneumoniae (85.5%), 8 E. coli (12.9%); and 1 P. mirabilis (1.6%). Only 2 isolates (0.2%), K. pneumoniae,and E. coli, had a carbapenem-resistance profile. Of these isolates, 591 (62.7%) were recovered from urine, 174 (18.5%) were recovered from blood, 92 (9.8%) were recovered from respiratory secretions, 19 (2%) were recovered from catheter tip, and 66 (7%) were recovered from elsewhere. Resistance rates to AMC, SAM, and TZP for each categorized
group (community-based, ESBL-producing, or CRE profile) are showninTable 1.Overall, amongthe BL/IBL combinations,TZP was the most active combination (14.6% of resistance rate), followed by AMC (32.3% of resistance rate) and SAM (51.9% of resistance rate). The greatest potency of activity was shown by TZP
January 1 and December 26, 2016, at a tertiary hospital in Porto Alegre, Southern Brazil. Escherichia coli, Klebsiella,and Proteus species were selected because other minor prevalent enterobacterial species such as Enterobacter, Providencia, Serratia, and Citrobacter freundii have an intrinsic resistance to amoxicillin/ clavulanate. Biochemical tests using a MicroScan automated system (Beckman Coulter, Brea, CA) were used to identify E. coli, Klebsiella,and Proteus species and to determine their resistance rates to amoxicillin/clavulanate (AMC), ampicillin/sulbactam (SAM), and piperacillin/tazobactam (TZP). All selected enter- obacterial isolates were confirmed for the presence of an ESBL enzyme using a synergistic test applying clavulanic acid, as previously described.2 Isolates with reduced susceptibility to any carbapenem agent were tested using a synergistic test applying phenyl-boronic acid and ethylenediaminetetraacetic acid to detect Klebsiella pneumoniae carbapenemase (KPC) and metallo-β-lactamase enzyme, in that order. Only CRE isolates with a negative result for any carbapenemase were included in this study. A total of 942 isolates were included in this survey; 878
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