Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 May;53(5):1712-4.
doi: 10.1128/JCM.03652-14. Epub 2015 Feb 18.

Impact of revised cefepime CLSI breakpoints on Escherichia coli and Klebsiella pneumoniae susceptibility and potential impact if applied to Pseudomonas aeruginosa

Yukihiro Hamada  1 , Christina A Sutherland  2 , David P Nicolau  3
Affiliations

Impact of revised cefepime CLSI breakpoints on Escherichia coli and Klebsiella pneumoniae susceptibility and potential impact if applied to Pseudomonas aeruginosa

Yukihiro Hamada et al. J Clin Microbiol. 2015 May.

Abstract

The CLSI reduced the cefepime Enterobacteriaceae susceptibility breakpoint and introduced the susceptible-dose-dependent (S-DD) category. In this study, MICs were determined for a Gram-negative collection to assess the impact of this change. For Enterobacteriaceae, this resulted in <2% reduction in susceptibility, with 1% being S-DD. If applied to Pseudomonas aeruginosa, the % susceptibility (%S) dropped from 77% to 43%, with 34% being S-DD. The new breakpoints did little to the Enterobacteriaceae %S, but for P. aeruginosa, a profound reduction was seen in %S. The recognition of a S-DD response to cefepime should alert clinicians to the possible need for higher doses.

PubMed Disclaimer

Figures

FIG 1
FIG 1
Cefepime MIC distribution for E. coli, K. pneumoniae, Citrobacter spp., Proteus spp., M. morganii, Enterobacter spp., K. oxytoca, S. marcescens, and P. aeruginosa. The MICs are on the x axis.
FIG 2
FIG 2
Comparison of cefepime percent susceptibility (%S), susceptible-dose-dependent (S-DD), and resistant (R) categories for Enterobacteriaceae (n = 2,596) and P. aeruginosa (n = 1,278), applying the 2014 Enterobacteriaceae breakpoints. p, pre-2014; a, after 2014. An asterisk (*) indicates that cefepime susceptibility (%S) was reduced from 77% to 43% (P < 0.01) for only P. aeruginosa.
FIG 3
FIG 3
Cefepime MIC distribution for phenotypically confirmed ESBL-producing Enterobacteriaceae. The MICs are on the x axis.
See this image and copyright information in PMC

Comment in

References

    1. Clinical and Laboratory Standards Institute. 2014. Performance standards for antimicrobial susceptibility testing; 24th informational supplement. CLSI document M100-S24 Clinical and Laboratory Standards Institute, Wayne, PA.
    1. Clinical and Laboratory Standards Institute. 2010. Performance standards for antimicrobial susceptibility testing; 20th informational supplement. CLSI document M100-S20 Clinical and Laboratory Standards Institute, Wayne, PA.
    1. Sutherland CA, Hamada Y, Nicolau DP. 2014. Impact of revised cefepime CLSI breakpoints on E. coli and K. pneumoniae susceptibility and potential impact if applied to P. aeruginosa, abstr C-099. Abstr 54th Intersci Conf Antimicrob Agents Chemother. American Society for Microbiology, 5 to 9 September 2014, Washington, DC.
    1. Dortet L, Poirel L, Nordmann P. 2012. Rapid identification of carbapenemase types in Enterobacteriaceae and Pseudomonas spp. by using a biochemical test. Antimicrob Agents Chemother 56:6437–6440. doi:10.1128/AAC.01395-12. - DOI - PMC - PubMed
    1. Jones RN, Kirby JT, Rhomberg PR. 2008. Comparative activity of meropenem in US medical centers (2007): initiating the 2nd decade of MYSTIC program surveillance. Diagn Microbiol Infect Dis 61:203–213. doi:10.1016/j.diagmicrobio.2008.01.017. - DOI - PubMed

Publication types

MeSH terms