What is the role of fourth generation cephalosporins in the treatment of Enterobacter infections?

Updated: Jun 18, 2019
  • Author: Susan L Fraser, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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The fourth-generation cephalosporin cefepime is relatively stable to the action of AmpC beta-lactamases; consequently, it retains moderate activity against the mutant strains of Enterobacter, hyperproducing AmpC beta-lactamases.

Ceftazidime-avibactam was initially approved in 2015 for the treatment of complicated intra-abdominal infections (cUTI) when given with metronidazole and complicated urinary tract infections (cUTI) due to susceptible organisms including E cloacae. It was subsequently approved for hospital-acquired and ventilator-associated pneumonia. It was also approved in March 2019 for treatment in children older than 3 months with cIAI (given with metronidazole) and cUTI. This antibiotic has been shown both in vitro and in vivo to have activity against multidrug-resistant E cloacae isolates. [28, 29]

Ceftaroline, a "fifth generation" cephalosporin with activity against S aureus and other staphylococci, including methicillin-resistant isolates, has activity and resistance potential against E cloacae complex isolates similar to those of third-generation cephalosporins. Ceftolozane-tazobactam had reliable activity against only wild-type E cloacae complex isolates, but not against ESBL or AmpC-overproducing strains. [30] Therefore, neither of these antibiotics would be considered useful for empirical treatment of serious Enterobacter infections.

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