Cefepime/Sulbactam — A New Innovative Antibiotic for In-Hospital Treatment of Severe Infections and the Implementation of Carbapenem-Replacement Strategy to Contain Antibiotic Resistance
Cefepime/sulbactam is a combined antibiotic consisting of the 4 th generation cephalosporin cefepime and the beta-lactamase inhibitor sulbactam in 1:1 ratio. Cefepime/sulbactam antibiotic was developed in Russia in 2006, it had passed preclinical and clinical studies, was approved for medical use, a...
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LLC "Publishing House OKI"
2021-06-01
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| Series: | Антибиотики и Химиотерапия |
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| Online Access: | https://www.antibiotics-chemotherapy.ru/jour/article/view/807 |
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| author | S. V. Yakovlev M. P. Suvorova A. O. Bykov |
| author_facet | S. V. Yakovlev M. P. Suvorova A. O. Bykov |
| author_sort | S. V. Yakovlev |
| collection | DOAJ |
| description | Cefepime/sulbactam is a combined antibiotic consisting of the 4 th generation cephalosporin cefepime and the beta-lactamase inhibitor sulbactam in 1:1 ratio. Cefepime/sulbactam antibiotic was developed in Russia in 2006, it had passed preclinical and clinical studies, was approved for medical use, and has been produced in Russia since 2019. Cefepime has a wide spectrum of antimicrobial activity against gram-positive and gram-negative microorganisms, sulbactam adds two clinically important pathogens to the antimicrobial spectrum of cefepime — Acinetobacter baumannii and Bacteroides fragilis. In addition, sulbactam protects cefepime from hydrolysis by class A broad- and extended-spectrum beta-lactamases, and cefepime itself is stable against class C chromosomal beta-lactamases and partially stable to OXA-type class D carbapenemases. In vitro studies have shown that most clinical strains of ESBL-producing Klebsiella pneumoniae, Escherichia coli, Proteus spp. are sensitive to cefepime/sulbactam, as well as some strains of K.pneumoniae and A.baumannii that are resistant to carbapenems as a result of the production of class D carbapenemases. The efficacy and safety of cefepime/sulbactam have been determined in three clinical studies. Clinical and bacteriological efficacy of the drug was 97.9% and 97.6% in patients with acute community-acquired pyelonephritis. In the MAXI-19 multicenter study, the clinical efficacy of cefepime/sulbactam in patients with intra-abdominal infections, nosocomial pneumonia, and ventilator-associated pneumonia was 78.4, 90.3, and 80.7%, respectively. A comparative study examined the efficacy of cefepime/sulbactam and carbapenems in severe nosocomial infections (84% of patients had sepsis or septic shock). Clinical efficacy of cefepime/sulbactam and carbapenems was high and did not significantly differ (71% vs. 62%), as well as the bacteriological efficacy — 87% vs. 73%, while typical hospital pathogens characterized by MDR or XDR were identified in the majority of patients (most often — K.pneumoniae, A.baumannii, E.coli). During treatment with carbapenems, carbapenem-resistant bacteria were detected significantly more often (74.5%, most often A.baumannii — 44.7%, K.pneumoniae — 38.3%), compared to cefepime/sulbactam (20.0%, P.aeruginosa and K.pneumoniae, both at 15.5%), P=0.0001. The risk of superinfection was also significantly higher with carbapenems than with cefepime/sulbactam (53.3% vs. 22.2%, P=0.001). For severe infections, cefepime/sulbactam was administered at a dose of 4 g (2 g + 2 g) every 12 hours or 2 g (1 g + 1 g) every 8 hours. Currently, cefepime/sulbactam should be considered as a reliable option for the treatment of severe infections in the hospital as a carbapenem-replacement strategy to reduce the risks of selection of carbapenem-resistant gram-negative bacteria. |
| format | Article |
| id | doaj-art-143f840f140c42408d729fa3b495d8a7 |
| institution | Kabale University |
| issn | 0235-2990 |
| language | Russian |
| publishDate | 2021-06-01 |
| publisher | LLC "Publishing House OKI" |
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| series | Антибиотики и Химиотерапия |
| spelling | doaj-art-143f840f140c42408d729fa3b495d8a72025-08-20T03:59:08ZrusLLC "Publishing House OKI"Антибиотики и Химиотерапия0235-29902021-06-01663-4829810.37489/0235-2990-2021-66-3-4-82-98779Cefepime/Sulbactam — A New Innovative Antibiotic for In-Hospital Treatment of Severe Infections and the Implementation of Carbapenem-Replacement Strategy to Contain Antibiotic ResistanceS. V. Yakovlev0M. P. Suvorova1A. O. Bykov2I. M. Sechenov First Moscow State Medical University; S. S. Yudin City Clinical HospitalI. M. Sechenov First Moscow State Medical University; S. S. Yudin City Clinical HospitalPirogov Russian National Research Medical University; City Clinical Hospital No. 40Cefepime/sulbactam is a combined antibiotic consisting of the 4 th generation cephalosporin cefepime and the beta-lactamase inhibitor sulbactam in 1:1 ratio. Cefepime/sulbactam antibiotic was developed in Russia in 2006, it had passed preclinical and clinical studies, was approved for medical use, and has been produced in Russia since 2019. Cefepime has a wide spectrum of antimicrobial activity against gram-positive and gram-negative microorganisms, sulbactam adds two clinically important pathogens to the antimicrobial spectrum of cefepime — Acinetobacter baumannii and Bacteroides fragilis. In addition, sulbactam protects cefepime from hydrolysis by class A broad- and extended-spectrum beta-lactamases, and cefepime itself is stable against class C chromosomal beta-lactamases and partially stable to OXA-type class D carbapenemases. In vitro studies have shown that most clinical strains of ESBL-producing Klebsiella pneumoniae, Escherichia coli, Proteus spp. are sensitive to cefepime/sulbactam, as well as some strains of K.pneumoniae and A.baumannii that are resistant to carbapenems as a result of the production of class D carbapenemases. The efficacy and safety of cefepime/sulbactam have been determined in three clinical studies. Clinical and bacteriological efficacy of the drug was 97.9% and 97.6% in patients with acute community-acquired pyelonephritis. In the MAXI-19 multicenter study, the clinical efficacy of cefepime/sulbactam in patients with intra-abdominal infections, nosocomial pneumonia, and ventilator-associated pneumonia was 78.4, 90.3, and 80.7%, respectively. A comparative study examined the efficacy of cefepime/sulbactam and carbapenems in severe nosocomial infections (84% of patients had sepsis or septic shock). Clinical efficacy of cefepime/sulbactam and carbapenems was high and did not significantly differ (71% vs. 62%), as well as the bacteriological efficacy — 87% vs. 73%, while typical hospital pathogens characterized by MDR or XDR were identified in the majority of patients (most often — K.pneumoniae, A.baumannii, E.coli). During treatment with carbapenems, carbapenem-resistant bacteria were detected significantly more often (74.5%, most often A.baumannii — 44.7%, K.pneumoniae — 38.3%), compared to cefepime/sulbactam (20.0%, P.aeruginosa and K.pneumoniae, both at 15.5%), P=0.0001. The risk of superinfection was also significantly higher with carbapenems than with cefepime/sulbactam (53.3% vs. 22.2%, P=0.001). For severe infections, cefepime/sulbactam was administered at a dose of 4 g (2 g + 2 g) every 12 hours or 2 g (1 g + 1 g) every 8 hours. Currently, cefepime/sulbactam should be considered as a reliable option for the treatment of severe infections in the hospital as a carbapenem-replacement strategy to reduce the risks of selection of carbapenem-resistant gram-negative bacteria.https://www.antibiotics-chemotherapy.ru/jour/article/view/807cefepime/sulbactambeta-lactam/beta-lactamase inhibitor combinationmulti-drug resistant pathogensextensively-drug resistant pathogensselection of resistancecarbapenem-replacement strategycarbapenem-sparing strategy |
| spellingShingle | S. V. Yakovlev M. P. Suvorova A. O. Bykov Cefepime/Sulbactam — A New Innovative Antibiotic for In-Hospital Treatment of Severe Infections and the Implementation of Carbapenem-Replacement Strategy to Contain Antibiotic Resistance Антибиотики и Химиотерапия cefepime/sulbactam beta-lactam/beta-lactamase inhibitor combination multi-drug resistant pathogens extensively-drug resistant pathogens selection of resistance carbapenem-replacement strategy carbapenem-sparing strategy |
| title | Cefepime/Sulbactam — A New Innovative Antibiotic for In-Hospital Treatment of Severe Infections and the Implementation of Carbapenem-Replacement Strategy to Contain Antibiotic Resistance |
| title_full | Cefepime/Sulbactam — A New Innovative Antibiotic for In-Hospital Treatment of Severe Infections and the Implementation of Carbapenem-Replacement Strategy to Contain Antibiotic Resistance |
| title_fullStr | Cefepime/Sulbactam — A New Innovative Antibiotic for In-Hospital Treatment of Severe Infections and the Implementation of Carbapenem-Replacement Strategy to Contain Antibiotic Resistance |
| title_full_unstemmed | Cefepime/Sulbactam — A New Innovative Antibiotic for In-Hospital Treatment of Severe Infections and the Implementation of Carbapenem-Replacement Strategy to Contain Antibiotic Resistance |
| title_short | Cefepime/Sulbactam — A New Innovative Antibiotic for In-Hospital Treatment of Severe Infections and the Implementation of Carbapenem-Replacement Strategy to Contain Antibiotic Resistance |
| title_sort | cefepime sulbactam a new innovative antibiotic for in hospital treatment of severe infections and the implementation of carbapenem replacement strategy to contain antibiotic resistance |
| topic | cefepime/sulbactam beta-lactam/beta-lactamase inhibitor combination multi-drug resistant pathogens extensively-drug resistant pathogens selection of resistance carbapenem-replacement strategy carbapenem-sparing strategy |
| url | https://www.antibiotics-chemotherapy.ru/jour/article/view/807 |
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