A performance evaluation and assessment study on differential in vitro susceptibility of recent clinical isolates in india to cefuroxime-clavulanic acid

Author: 
Sonali Sanghavi, Meenakshi Satpute, Nilima Telang, Prashant Agrawal, Saher Khan and Monjori Mitra

Background: It is essential to investigate the effectiveness of antibiotics in the present-day scenario, especially because of the increasing threat of antimicrobial resistance. Cefuroxime, a second-generation cephalosporin, has a broad spectrum of antimicrobial activity. However, there is a dearth of data on the current susceptibility of pathogenic bacteria to cefuroxime or its combinations. Objective: This study aimed to evaluate the in vitro susceptibility of clinical isolates to cefuroxime in combination with β-lactamase inhibitor, clavulanic acid, as there are no clinical breakpoints for interpretation of antimicrobial susceptibility. Methods: Bacterial isolates were cultured from non-repetitive clinical samples from January to February 2024 at a single center in India. Minimum inhibitory concentration (MIC) of cefuroxime + clavulanic acid was evaluated using Epsilometer test (E-test). The MIC values thus obtained were used to assess susceptibility of isolates. Results: Among 100 clinical isolates tested, 78% were gram negative and 22% were gram positive. Escherichia coli was the most prevalent pathogen (38%), followed by Klebsiella pneumoniae (24%) and Staphylococcus aureus (16%). Since breakpoints for cefuroxime + clavulanic acid are not available, the corresponding values for cefuroxime provided in EUCAST and/or CLSI were used to deduce conclusions about susceptibility. Accordingly, susceptibility/intermediate susceptibility to cefuroxime + clavulanic acid was displayed by 68.42% of E. coli, 41.67% of K. pneumoniae, and 12.50% of S. aureus isolates. Other less-prevalent bacteria such as Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Citrobacter koseri, Salmonella enterica, Proteus vulgaris, and Pantoea spp. were also found to be susceptible/intermediately susceptible to cefuroxime + clavulanic acid. Conclusions: A fixed-dose combination (FDC) of cefuroxime and clavulanic acid was effective against pathogens like E. coli, K. pneumoniae, S. aureus, and others. Given these broad spectra of activity, this FDC appear well-suited for use in the treatment of a variety of healthcare-associated infections, such as pneumonia, surgical sepsis and/or bacteremia, UTIs, etc.

Paper No: 
5632