ArticleAnnals of clinical microbiology and antimicrobials2014
The inoculum effect of antibiotics against CTX-M-extended-spectrum β-lactamase-producing Escherichia coli.
Article in Annals of clinical microbiology and antimicrobials, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 28 citations in OpenAlex.
- Inoculum Effect in Multidrug-Resistant Gram-Negative Isolates: Impact on Ceftazidime and Cefepime Susceptibility.Current microbiology · 2026Article
- Cumulative cefepime exposure in cancer patients is associated with an increased risk of ertapenem non-susceptible, meropenem susceptible Enterobacterales bacteremia.Microbiology spectrum · 2026Article
- One health analysis of antimicrobial resistance inBioinformatics advances · 2026Article
- Rapid direct disk diffusion testing for antibiotic resistance in urinary tract infections: a bacterial concentration-adjusted approach.Microbiology spectrum · 2025Article
- In Vitro Dynamic Model Evaluation of Meropenem Alone and in Combination with Avibactam Against Carbapenemase-ProducingPharmaceuticals (Basel, Switzerland) · 2024Article
- Comparison of the inoculum effect of in vitro antibacterial activity of Imipenem/relebactam and Ceftazidime/avibactam against ESBL-, KPC- and AmpC-producing Escherichia coli and Klebsiella pneumoniae.Annals of clinical microbiology and antimicrobials · 2023Article
- Demographic, clinical, and outcome characteristics of carbapenem-resistant Enterobacteriaceae over a 10-year period (2010-2020) in Oman.IJID regions · 2022Article
- Article
- Inoculum effect of Enterobacterales co-expressing OXA-48 and CTX-M on the susceptibility to ceftazidime/avibactam and meropenem.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2022Article
- Antibacterial Profile of a Microbicidal Agent Targeting Tyrosine Phosphatases and Redox Thiols, Novel Drug Targets.Antibiotics (Basel, Switzerland) · 2021Article
- Unfractionated Heparin Improves the Intestinal Microcirculation in a Canine Septic Shock Model.Mediators of inflammation · 2021Article
- Inoculum effect of β-lactam antibiotics.The Journal of antimicrobial chemotherapy · 2019Review
- Article
- Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae.Clinical microbiology reviews · 2018Review
- Distribution and drug resistance of pathogenic bacteria in ventilator-associated pneumonia at a local hospital of North-eastern China.Infection and drug resistance · 2018Article
- Piperacillin-tazobactam as alternative to carbapenems for ICU patients.Annals of intensive care · 2017Review
- Updates in the Management of Cephalosporin-Resistant Gram-Negative Bacteria.Current infectious disease reports · 2016Review
- Examining the Clinical Effectiveness of Non-Carbapenem β-Lactams for the Treatment of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae.Antibiotics (Basel, Switzerland) · 2015Review
- Direct disk diffusion test using European Clinical Antimicrobial Susceptibility Testing breakpoints provides reliable results compared with the standard method.European journal of microbiology & immunology · 2015Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundQuestions remain regarding the use of the cephalosporins to treat infections caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. For example, should ceftazidime or cefepime be used to treat infections with CTX-M ESBL-producing organisms with low MICs (minimum inhibitory concentrations), according to the new Clinical and Laboratory Standards Institute's (CLSI) recommendations for susceptibility testing? Some studies have reported that in vitro MICs of cephalosporins increase as the inoculum increases, which is the inoculum effect; however, most of the enzymes studied were SHV and TEM. In this study, we aimed to investigate the inoculum effect on ceftazidime, cefepime and four other β-lactam agents against CTX-M-ESBLs-producing Escherichia coli.
methodsAntibiotic susceptibilities were determined using broth microdilution MIC methodology according to the CLSI recommended with standard and 100-fold-higher inocula.
resultsAn inoculum effect on meropenem and cefminox was not detected. The size of the inoculum affected piperacillin/tazobactam activity against only 4 strains, all CTX-M-14 genotypes. The inoculum size affected the activity of ceftazidime, cefepime and cefotaxime against 35%, 85%, 100% of strains, respectively. Among the strains with an inoculum effect, CTX-M-14 was the most common ESBL genotype.
conclusionsThese findings suggest that meropenem is the most active compound against serious infections caused by Escherichia coli producing ESBLs. Cefminox and piperacillin-tazobactam exhibit strong activity against many strains. Until further studies are performed, clinicians should be aware that third- and fourth-generation cephalosporins (such as ceftazidime and cefepime) are not reliable for serious infections even though in vitro tests indicate susceptibility.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.