Evaluating the in vitro activity of cefoperazone-sulbactam against Gram negative pathogens in blood stream infections using automated systems
Abstract
Background and Objectives: The incidence of multidrug-resistant, Gram-negative organisms, isolated as the etiological agents of infections is ascending. The advent of novel antibiotics poses significant challenges, necessitating the optimization and utilization of extant antimicrobial agents. Cefoperazone, a third-generation cephalosporin and β-lactam antimicrobial, when combined with sulbactam, an irreversible β-lactamase inhibitor, mitigates the vulnerability of cefoperazone to β-lactamase-producing organisms. Nonetheless, regional data on the susceptibility patterns for this pharmacological combination remains scarce. The primary objective of this investigation was to assess the efficacy of the cefoperazone-sulbactam combination against prevalent Gram-negative bacteria isolated from blood cultures.
Materials and Methods: A total of 700 Gram-negative isolates, comprising Escherichia coli, Klebsiella pneumoniae, Acinetobacter species, and Pseudomonas aeruginosa, were procured using the BacT/Alert 3D system. The identification and susceptibility testing for cefoperazone-sulbactam were performed using the VITEK Compact ID and AST system. Comparative analysis was conducted against other tested antibiotics.
Results: The study revealed that cefoperazone-sulbactam exhibited commendable in-vitro activity against Gram-negative pathogens isolated from blood, surpassed only by colistin and tigecycline.
Conclusion: Cefoperazone-sulbactam demonstrates robust activity against the most frequently encountered clinical pathogens, suggesting its potential as an efficacious therapeutic agent. The findings underscore the imperative for ongoing surveillance of resistance patterns and trends among commonly used antimicrobials.
2. World Health Organization (2024). WHO bacterial priority pathogens list, 2024: Bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. https://www.who.int/publications/i/item/9789240093461
3. Chiang T-T, Tang T-H, Chiu C-H, Chen T-L, Ho M-W, Lee C-H, et al. Antimicrobial activities of cefoperazone-sulbactam in comparison to cefoperazone against clinical organisms from medical centers in Taiwan. J Med Sci 2016; 36: 229-233.
4. Kuo HY, Wang FD, Yen YF, Lin ML, Liu CY. In vitro activities of piperacillin or cefoperazone alone and in combination with beta-lactamase inhibitors against gram-negative bacilli. New Microbiol 2009; 32: 49-55.
5. Pfaller MA, Flamm RK, Duncan LR, Mendes RE, Jones RN, Sader HS. Antimicrobial activity of tigecycline and cefoperazone/sulbactam tested against 18,386 Gram-negative organisms from Europe and the Asia-Pacific region (2013–2014). Diagn Microbiol Infect Dis 2017; 88: 177-183.
6. Chen C-H, Tu C-Y, Chen W-C, Kuo L-K, Wang Y-T, Fu P-K, et al. Clinical efficacy of cefoperazone-sulbactam versus piperacillin-tazobactam in the treatment of hospital-acquired Pneumonia and ventilator-associated Pneumonia. Infect Drug Resist 2021; 14: 2251-2258.
7. Aynioglu A, Mutlu B, Hacihanefioglu A. A comparison of the efficacy of piperacillin-tazobactam and cefoperazone-sulbactam therapies in the empirical treatment of patients with febrile neutropenia. Rev Esp Quimioter 2016; 29: 69-75.
8. Poudyal N, Gyawali N, Gurung R, Bhattarai NR, Baral R, Khanal B, et al. In vitro activity of cefoperazone-sulbactam combination against gram negative bacilli. Nepal Med Coll J 2012; 14: 5-8.
9. Sader HS, Carvalhaes CG, Streit JM, Castanheira M, Flamm RK. Antimicrobial activity of cefoperazone-sulbactam tested against Gram-Negative organisms from Europe, Asia-Pacific, and Latin America. Int J Infect Dis 2020; 91: 32-37.
10. CLSI M100 (2024). Performance Standards for Antimicrobial Susceptibility Testing, 34th Edition.
11. Zhang S, Liao X, Ding T, Ahn J. Role of β-lactamase inhibitors as potentiators in antimicrobial chemotherapy targeting Gram-negative bacteria. Antibiotics (Basel) 2024; 13: 260.
12. Lin SY, Lu PL, Wu TS, Shie SS, Chang FY, Yang YS, et al. Correlation between Cefoperazone/Sulbactam MIC Values and clinical outcomes of Escherichia coli Bacteremia. Infect Dis Ther 2022; 11: 1853-1867.
13. Sheu M-J, Chen C-C, Lu Y-C, Su B-A, Zhang C-C, Wang S-S, et al. In vitro antimicrobial activity of Various Cefoperazone/Sulbactam products. Antibiotics (Basel) 2020; 9: 77.
14. Chang PC, Chen CC, Lu YC, Lai CC, Huang HL, Chuang YC, et al. The impact of inoculum size on the activity of cefoperazone-sulbactam against multidrug resistant organisms. J Microbiol Immunol Infect 2018; 51: 207-213.
15. Kucutkates E, Kocazeybek B. High resistance rate against 15 different antibiotics in aerobic gram negative bacteria isolates of cardiology cardiac care unit patients. Indian J Med Microbiol 2002; 20: 208-210.
16. Gupta V, Datta P, Agnihotri N, Chander J. Comparative in vitro activities of seven new beta-lactams, alone and in combination with beta-lactamase inhibitors, against clinical isolates resistant to third generation cephalosporins. Braz J Infect Dis 2006; 10: 22-25.
17. Paterson DL. Recommendation for treatment of severe infections caused by Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs). Clin Microbiol Infect 2000; 6: 460-463.
18. Pitout JD, Laupland KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: An emerging public-health concern. Lancet Infect Dis 2008; 8: 159-166.
19. World Health Organisation (2024). WHO updates list of drug-resistant bacteria most threatening to human health. Available from: https://www.who.int/news/item/17-05-2024-who-updates-list-of-drug-resistant-bacteria-most-threatening-to-human-health
20. Huang C, Lin L, Kuo S. Comparing the outcomes of cefoperazone/sulbactam-based and non-cefoperazone/sulbactam-based therapeutic regimens in patients with multiresistant Acinetobacter baumannii infections-a meta-analysis. Antibiotics (Basel) 2024; 13: 907.
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Issue | Vol 16 No 6 (2024) | |
Section | Original Article(s) | |
DOI | https://doi.org/10.18502/ijm.v16i6.17245 | |
Keywords | ||
Antimicrobial resistance; Cefoperazone/sulbactam; Gram negative isolates |
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