In Vitro Activities of Ertapenem and Imipenem against Clinical Extended Spectrum Beta-Lactamase-Producing Enterobacteriaceae Collected in Military Teaching Hospital Mohammed V of Rabat
Objective. To study the sensitivity level of extended spectrum beta-lactamase-producing Enterobacteriaceae to Carbapenems (Imipenem, Ertapenem) marketed in Morocco and discusses the place of Ertapenem in the treatment of extended spectrum-beta-lactamase-producing. Materials and Methods. A retrospective study of 110 extended spectrum beta-lactamase-producing Enterobacteriaceae. Isolates obtained from blood cultures, superficial and deep pus, and catheters were conducted. The minimum inhibitory concentrations of Imipenem and Ertapenem were done by the E-test. The modified Hodge test was conducted for resistant or intermediate strains. Results. 99.1% of isolates were susceptible to Imipenem. For Ertapenem, 4 were resistant and 4 intermediate. The modified Hodge test was positive for all 08 isolates. A minimum inhibitory concentration comparison of K. pneumoniae, E. cloacae, and E. coli for Imipenem has noted a significant difference between E. cloacae on one hand and E. coli, K. pneumoniae on the other hand ( ). No significant difference was noted for minimum inhibitory concentration of Ertapenem. Conclusion. Our results confirm in vitro effectiveness of Ertapenem against extended spectrum beta-lactamase-producing Enterobacteriaceae as reported elsewhere. However, the emergence of resistance to Carbapenems revealed by production of carbapenemases in this study confirmed a necessary bacteriological documented infection before using Ertapenem. 1. Introduction Extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-EB) represent a major health problem because of their multiple resistances to antibiotics. Treatment options are limited, often using the Carbapenems, cephamycins, fosfomycin, furans, and colimycin [1–4]. The results of clinical studies suggest that Imipenem remains the primary choice of treatment for bacteria that produces ESBLs [5–9]. These results increase in overall the prescription of Imipenem, an overbill and an additional selection pressure on the ecosystem, causing and maintaining in our region the multidrug resistance Acinetobacter baumannii and Pseudomonas aeruginosa endemicity, and recently the emergence of Enterobacteriaceae carbapenem-resistant strains [10, 11]. In Morocco, there are two available Carbapenems: Imipenem (IMP) and Ertapenem (ERT). Ertapenem is the second molecule of the family on the market since 2008. The aim of our work was to study the ESBL-EB sensitivity to Carbapenems marketed in Morocco, to discuss the impact of use of Imipenem on the emergence of resistance to Carbapenems, and the Ertapenem place’s in
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