Cephalosporins
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
Cefoxitin has Gram-negative activity that is similar to cefuroxime. However, compared with other first- and second-generation cephalosporins, its activity against streptococci and MSSA is significantly reduced (15). It is the most active cephalosporin against B.fragilis, although its activity against the other Bacteroides spp., such as B. thetaiotaomicron or B ovatus, is less. It is highly active against N. gonorrhoeae, and is used in empirical therapy for pelvic inflammatory disease. Cefotetan is similar to cefoxitin except for a long half-life that permits twice-daily dosing, and less activity against the non-fragilis Bacteroides spp.(16). Unlike cefoxitin, it has an jV-methylthiotetrazole (NMTT) group, which has been associated with hypopro-thrombinemia and bleeding. Most hospital pharmacies consider cefoxitin and cefotetan interchangeable, and may have only one on their formulary. The cephamycins are effective in the treatment of mixed aerobic-anaerobic infections, such as pelvic, abdominal, or diabetic foot infections. However, metronidazole and clindamycin have superior activity against Bacteroides spp. The cephamycins should not be used as monotherapy for nosocomial infections and serious nursing-home infections, or when reliable coverage against MSSA is needed. They are used for antimicrobial prophylaxis of colorectal surgery or for appendectomy, which would have clinical relevance to the elderly.
Cefoxitin, Cefotetan, and Other Cephamycins
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
Structurally, the cephamycins are related to but distinct from cephalosporin C. Both contain a 7-alpha-methoxy group (Komiya et al., 1981; Ayers et al., 1982). Cefotetan possesses an N-methylthiotetrazole side chain (Cohen et al., 1987; Ward and Richards, 1989; Figure 24.1). These antibiotics act on bacteria in a manner similar to other beta-lactam antibiotics.
Molecular diagnosis of antimicrobial resistance in Escherichia coli
Published in Expert Review of Molecular Diagnostics, 2018
Molly E Fleece, Suporn Pholwat, Amy J Mathers, Eric R Houpt
Ambler Class C/Bush-Jacoby group 1 enzymes include AmpC beta-lactamases. Whereas these enzymes have activity against penicillins, they have particularly high affinity and activity against cephalosporins, including cephamycins and oxyimino-beta-lactams, and monobactams. Class C enzymes are resistant to inhibition by beta-lactamase inhibitors [38]. Wild-type E. coli expresses low levels of chromosomally encoded AmpC enzymes constitutively. Overproduction of the chromosomal ampC gene or acquisition of a plasmid-mediated ampC gene results in higher levels of AmpC beta-lactamase production [39]. In E. coli, the most commonly identified plasmid-mediated AmpC enzyme is CMY-2 [34]. Other examples include CMY-6, LAT-1, FOX-5, and DHA-1 [39].
High rates of antimicrobial resistance of ESBL-producing Enterobacteriaceae isolated from clinical samples in Northeast of Brazil
Published in Infectious Diseases, 2018
Miguel Araújo Rios Neto, Vaneska Magalhães Rios, Luiza Franco Corá, Marcela Machado Fonseca, Kennio Ferreira-Paim, Fernanda Machado Fonseca
Table 1 shows the antimicrobial susceptibility profile of ESBL-producing enterobacteria. Within carbapenems, susceptibility to imipenem was found in 89.7% (n = 26) and to meropenem in 72.4% (n = 21). Among aminoglycosides, susceptibility to amikacin was 82.8% (n = 24) and to gentamicin 69.0% (n = 20). Susceptibility to nitrofurantoin (nitrofuran) and cefoxitin (cephamycin) occurred in 48.3% (n = 14) and 24.1% (n = 7), respectively.
Perioperative antimicrobial prophylaxis in patients undergoing pancreatoduodenectomy: retrospective analysis of bacteriological profile and susceptibility
Published in Acta Chirurgica Belgica, 2023
Reza Chinikar, Daniel Patricio, Juliette Gosse, Brigitte Ickx, Myriam Delhaye, Jean Closset, Imad El Moussaoui, Maya Hites, Julie Navez
The most frequently isolated germs in bile cultures were Escherichia coli, Klebsiella spp. and Enterobacter spp., which are similar to those reported in the literature [19–21]. While Escherichia Coli and Klebsiella species are susceptible to cefuroxime (2nd-generation cephalosporin) in 60–70% of cases, Enterobacter species need a broad-spectrum antimicrobial therapy, as it is currently not covered by our routine antimicrobial prophylaxis protocol. For Enterococcus spp., it is pretty widely accepted that these pathogens do not need to be covered immediately or prophylactically. We need to treat these pathogens when they are preponderant in the samples [22]. There are no clear expert guidelines regarding the type and the duration of antibiotic prophylaxis in the perioperative course of patients undergoing PD. While multiple-drug-resistant microorganisms are an increasing concern a rational use of antibiotics should be encouraged. In our institution, cefazolin (1st-generation cephalosporin) and metronidazole were given intraoperatively in nearly all patients (91%), except in patients who had cefuroxime resistant bacteria at the preoperative bile sample during PBD (9%, n = 15). Based on microorganisms isolated in bile culture, this antimicrobial prophylaxis appeared to be inappropriate in a number of patients undergoing PBD, according to the reduced susceptibility y to cefuroxime (2nd-generation cephalosporin) in a significant percentage of patients (Table 5). The same protocol has been evaluated by Hentzen et al. and was appropriate in only 56% of PBD + patients and in 88% of PBD– patients [20]. They advocated to add gentamycin to provide prophylaxis against all potential pathogens in nearly 100% of patients. The French team from Beaujon Hospital suggested to adapt the antimicrobial prophylaxis according to the risk of bile contamination, considering a low-risk group and a high-risk group [19]. This latter group included any patient with a malignant ampullary tumour or undergoing preoperative endoscopic procedure (sphincterotomy, brushing, endoprosthesis or nasobiliary drainage). While the low-risk group received intraoperative cefoxitin (2nd-generation cephamycin), the high-risk group received a broad-spectrum antimicrobial prophylaxis which was continued for 48-h postoperatively. In case of positive bile culture, antibacterial strategy was adapted and pursued until postoperative day 5. This implemented protocol resulted in less infectious complications in the high-risk group. Based on our epidemiological data, considering patients undergoing PD as high-risk and low-risk groups would also lead to a different prophylactic antibacterial strategy than currently implemented in our institution. Indeed, while current administration of cefazolin and metronidazole would cover most pathogens in the low-risk group, the administration of piperacillin–tazobactam or cefepime combined with metronidazole would cover a majority of pathogens identified in the high-risk group undergoing PBD prior to PD.
Related Knowledge Centers
- Cefmetazole
- Cefotetan
- Cefoxitin
- Cephalosporin
- Streptomyces
- Beta-Lactam Antibiotics