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Open Access Research article

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

Despina Hatzaki1, Garyphallia Poulakou2*, Ioannis Katsarolis2, Niki Lambri2, Maria Souli2, Ioannis Deliolanis3, Georgios K Nikolopoulos4, Evangelia Lebessi1 and Helen Giamarellou25

Author Affiliations

1 Department of Microbiology, “P. and A. Kyriakou” Children’s Hospital, Thibon and Levadeias, 11527, Athens, Greece

2 4th Department of Internal Medicine and Infectious Diseases Research Laboratory, Athens University School of Medicine, 1, Rimini St, 12462, Haidari, Athens, Greece

3 Department of Microbiology, “Laikon” General Hospital of Athens, 17 Agiou Thoma St, 11527, Athens, Greece

4 Hellenic Centre for Disease Control and Prevention, 3-5 Agrafon St, 15123, Maroussi, Athens, Greece

5 6th Department of Internal Medicine, Hygeia Hospital, 4 Erythrou Stavrou st and Kifissias Ave, 15123, Maroussi, Athens, Greece

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BMC Infectious Diseases 2012, 12:228  doi:10.1186/1471-2334-12-228

Published: 25 September 2012

Abstract

Background

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

Methods

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.

Results

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.

Conclusions

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.

Keywords:
Urinary tract infections; Acute uncomplicated cystitis; Cephalosporins; Antimicrobial resistance; Empirical treatment