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JAC Advance Access originally published online on January 3, 2008
Journal of Antimicrobial Chemotherapy 2008 61(2):309-314; doi:10.1093/jac/dkm494
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Role of β-lactamase inhibitors in enterobacterial isolates producing extended-spectrum β-lactamases

Amitabha Bhattacharjee, Malay Ranjan Sen*, Pradyot Prakash and Shampa Anupurba

Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India

Received 3 September 2007; returned 8 October 2007; revised 22 November 2007; accepted 23 November 2007

* Corresponding author. Tel: +91-9415820675; E-mail: mr_senbhu{at}yahoo.com

Objectives: To determine the in vitro activity of β-lactamase inhibitors (clavulanic acid and sulbactam) in combination with third-generation cephalosporins and monobactam against extended-spectrum β-lactamase (ESBL)-producing members of the Enterobacteriaceae family.

Methods: A total of 361 ESBL-producing enterobacterial isolates obtained from patients of a university hospital were screened for the status of co-production of AmpC β-lactamase. These strains were further subjected to an MIC study using third-generation cephalosporins and monobactam, and reductions were observed after combining with β-lactamase inhibitors at a fixed concentration of 4 mg/L.

Results: Most of the isolates showed 8-fold reduction with sulbactam when combined with ceftriaxone, cefpodoxime and cefotaxime but not with ceftazidime and aztreonam, whereas clavulanic acid showed the same result with all the cephalosporins tested. Further, both the inhibitors showed greater reduced MIC when combined with aztreonam.

Conclusions: As the ability of clavulanic acid to induce AmpC production may interfere with ESBL detection, sulbactam is likely to be preferred over clavulanic acid after standardization of an appropriate concentration for ESBL detection in the scenario of increased prevalence of AmpC producers. Greater in vitro activity of these inhibitors when combined with aztreonam further indicates the need of studies to evaluate these combination antimicrobials in clinical settings as they can play a significant role for clinicians as viable alternatives to treat infections caused by such organisms.

Keywords: ESBLs , OXA-10 , aztreonam


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