Cefditoren: Comparative efficacy with other antimicrobials and risk factors for resistance in clinical isolates causing UTIs in outpatients

• Published in: BMC infectious diseases 2012-09, Vol.12 (1), p.228-228, Article 228
• Main Authors: Hatzaki, Despina, Poulakou, Garyphallia, Katsarolis, Ioannis, Lambri, Niki, Souli, Maria, Deliolanis, Ioannis, Nikolopoulos, Georgios K, Lebessi, Evangelia, Giamarellou, Helen
• Format: Article
• Language: English
• Subjects: Acute uncomplicated cystitis; Adolescent; Adult; Aged; Aged, 80 and over; Aminoglycosides; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Antimicrobial resistance; Bacterial infections; Catheters; Cefditoren; Cefuroxime; Cefuroxime axetil; Cephalosporins; Cephalosporins - therapeutic use; Ciprofloxacin; Comparative analysis; Drug resistance in microorganisms; Drug Resistance, Bacterial; Drug therapy; Empirical treatment; Enterobacteriaceae; Enterobacteriaceae - drug effects; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - drug therapy; Enterobacteriaceae Infections - microbiology; Enzymes; Escherichia coli; Excretory system; Female; Greece; Health aspects; Hospitals; Humans; Infections; Internal medicine; Klebsiella; Laboratories; Male; Medical colleges; Medicine; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; Outpatients; Pregnancy; Proteus mirabilis; Risk Factors; Shipments; Statistical analysis; Studies; Surveys; Treatment Outcome; Urinary tract infections; Urinary Tract Infections - drug therapy; Urinary Tract Infections - microbiology; Urogenital system; Young Adult
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/1471-2334-12-228

To investigate a possible role of Cefditoren, a recently marketed in Greece third-generation oral cephalosporin in urinary infections of outpatients. During 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. A 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. Cefditoren 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.