Short communicationComparative in vitro activity of ertapenem against extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolated in Spain
Introduction
Ertapenem is a new carbapenem active against most Gram-positive and Gram-negative aerobic and anaerobic microorganisms commonly recovered from non-hospitalised patients [1]. This once-daily parenteral β-lactam agent was licensed in November 2001 in the USA for the treatment of complicated intra-abdominal infections, community-acquired pneumonia, acute pelvic infections, complicated urinary tract infections and complicated skin and soft tissue infections [2]. Licensure in Europe followed in April 2002 for the treatment of complicated intra-abdominal infections, community-acquired pneumonia and acute pelvic infections caused by susceptible strains of certain designated organisms.
With the exception of metallo-β-lactamases and a few other carbapenemases, ertapenem is highly resistant to β-lactamases, including extended-spectrum β-lactamases (ESBLs).
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Material and methods
Strains analysed in this work came from two Spanish studies of ESBL-producing Enterobacteriaceae: the first was undertaken in 2000 and included 40 hospitals representing 14 of the 17 regions in Spain [3]; the second was carried out at University Hospital Virgen Macarena (HUVM) in Seville with strains recovered between 1995 and 2001 [4]. Antimicrobial susceptibility and detection of ESBL production were carried out by broth microdilution according to the Clinical and Laboratory Standards
Results
Here we evaluated the activity of ertapenem against 289 Escherichia coli and 174 Klebsiella pneumoniae isolates producing known ESBLs. The ertapenem minimum inhibitory concentration for 90% of the organisms (MIC90) for E. coli isolates was 0.125 μg/mL (Table 1); no resistant isolate was found. The ertapenem MIC for one E. coli isolate (HUVM190) was 4 μg/mL and, according to CLSI breakpoints, should be included in the intermediate category [5]. In another E. coli isolate (HUVM194), the ertapenem
Discussion
Isolation of ESBL-producing Enterobacteriaceae is increasing in Spain. A high proportion of ESBL-producing E. coli has been isolated from non-hospitalised patients in this country [3], [4], [6], [7], [8]. Bou et al. reported that only 7 of 30 patients harbouring strains with ESBL ever had previous contact with the hospital environment before the clinical isolation of E. coli [6]. Our group has recently reported an ESBL-producing E. coli prevalence in Spain of 0.5%, and 51% of these were
Acknowledgments
The authors thank the Grupo Español de Infección Hospitalaria (GEIH) for kindly providing some of the strains used in this study. The study was developed under the auspices of the Red Española de Investigación en Patología Infecciosa (REIPI) of the Ministerio de Sanidad in Spain (C03-014). The study was partially supported by a grant from Merck Sharp and Dohme.
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Present address: Department of Microbiology, University Hospital Marqués de Valdecilla, Av. de Valdecilla, 39008 Santander, Spain.