a%?i&a& zyxwvut ELSEVIER zyxwvutsr Evaluation of the In Vitro Activity of Cefepime Compared to Other Broad- Spectrum Cephalosporins Against Clinical Isolates from Eighteen Brazilian Hospitals by Using the Etest zyxwvutsrqponmlkjihgfedcbaZYXWVU Helio S. Sader, Igor Mimiqa, Flhvia Rossi, Uissia Zoccoli, A. C. Montelli, Jorge L. M. Sampaio, Adilia J. A. Segura, Marcel0 Magalhges, Angela Nowakonski, and Caio M. F. Mendes zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Tlze in vitro activity of cefepime was compared to that of cefta- zidime, ceftriaxone, and cefotaxime in a mzzlficenter study in- volving 10 clinical microbiology laboratories and clinical iso- latesfkom 18 Brazilian hospitals from 7 cities (4 states). A total of 982 isolates conseczltively collected between December 1995 azzd March 1996 were szzsceptibility tested by using Etest and followizzg the NCCLS procedures for agar diffusion tests. The cefepime spectrum was broader thazz that of the other broad-spectrum cepplzalosporins against both Gram- zzegative rods and Gram-positive cocci. Cefepime was particu- larly more active against Enterobacter sp. (MI&o, 2 t.zg/ml), Serratia sp. (Ml&, 2 t_cg/ml) and oxacillin-susceptible INTRODUCTION Cefepime is a fourth-generation cephalosporin with a spectrum of antibacterial activity broader than that of the third-generation cephalosporins (Sader and Jones 1992). The fact that cefepime is stable to hydro- lysis to many of the common plasmid- and chromo- somally mediated p-lactamases indicates that From the Federal University of S%o Pa&--UNIFESP/ EPM (HSS), Sao Paulo, SF’; Santa Casa de Misericordia de SIo Paulo (IM), Sao Paulo, SF; Emilio Ribas Hospital (FR), Sao Paulo, SP; Santa Luzia Laboratory (CZ), Florianopolis, SC; Faculdade de Medicina de Botucatu-UNESP (ACM), Botucatu, SP; Ldmina Laboratory (JLMS), Rio de Janeiro, RJ; Hospital de Base de Bra- silia-FHDF (AJAS), Brasilia, DF; Marcel0 Magalhaes Labora- tory (MM), Recife, PE; Hospital das Clinicas da UNICAMP (AN), Campinas, SF’; University of S%o Paula College of Medicine-HC-FMUSP (CMFM), SBo Paulo, SP, Brazil. Address reprint requests to Helio S. Sader, M.D., Division of Infectious Diseases, Universidade Federal de S%o Paulo/ EPM, Rua Botucatu, 740-SIo Paulo, SP-04023-062-Brazil. Received 3 February; revised and accepted 4 March 1997. DIAGN MICROBIOL INFECT DIS 1997;28:87-92 0 1997 Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010 Staphylococcus aureus (MK, 3 pg/ml). Against Pseudo- monas aeruginosa, cefepinze (MI&o, 16 pg/ml) was slightly more active than ceftazidime (Ml&,,, 32 t.zg/ml) and 8- to 16- fold nzore active than ceftriaxone or cefotaxinze (MIC,,, >256 t.zg/ml). Our results show that nosocomial bacteria, especially Gram-negative rods, have a higtz rate of cephalosporin resis- tance in Brazil. However, part of these resistant bacteria re- mains susceptible to cefepime. The Etest was shown to be an excellezzt method for multicenter studies of the in vitro evalua- tion of new antimicrobial agents. 0 1997 Elsevier Science Inc. cefepime may be useful for the treatment of infec- tions resistant to earlier cephalosporins (Phelps et al. 1986). Cefepime has demonstrated high inhibitory activity against all common pathogens from Enter- obacteriaceae species, especially those that commonly produce chromosomally mediated p-lactamases, such as Enterobacter sp. and Serratia marcescens (Fuchs et al. 1985; Sanders 1993). Cefepime has also excellent inhibitory activity against Haemophilus influentae, re- gardless of the ,&lactamase-producing ability of the organism. Furthermore, unlike imipenem and some second-generation cephalosporins, cefepime is a poor inducer of type I p-lactamases (Barradel and Bryson 1994). Experimental models of infections have generally found cefepime to have activity su- perior to that of ceftazidime and cefotaxime against most clinically important Gram-positive and Gram- negative organisms. However, against infections 0732-8893/ 97/ $17.00 PI1 SO732-8893(97)00015-l