ReviewThe Journal of antimicrobial chemotherapy2019
Inoculum effect of β-lactam antibiotics.
Review in The Journal of antimicrobial chemotherapy, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 92 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
92 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pharmacokinetic-pharmacodynamic modeling using combined time-kill data for meropenem and colistin or polymyxin B combination effects inAntimicrobial agents and chemotherapy · 2026Pooled it
- Systematic review of antimicrobial pharmacokinetic/pharmacodynamic indices in murine thigh and hollow fibre dose fractionation studies analysed with a standard method.The Journal of antimicrobial chemotherapy · 2026Pooled it
- Rising Carbapenem MICs and Clinical Dose Optimization: Bridging Resistance Surveillance and Pharmacokinetic/Pharmacodynamic Strategies.Antibiotics (Basel, Switzerland) · 2026Review
- Artificial Intelligence-Empowered Single-Cell Phenotyping for Rapid, Automated Pathogen Diagnostics.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- Rifampicin as an antivirulence adjunct in hypervirulent/hypermucoviscous Klebsiella pneumoniae infections: a scoping review.BMC infectious diseases · 2026Article
- Ignavigranum ruoffiae isolated from a scrotal abscess: a case report and literature review.BMC infectious diseases · 2026Review
- ASP-COMPLEX: redefining antimicrobial stewardship to improve outcomes in high-risk patients with severe infections.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2026Review
- Reply to Zimhony and Yakovenko.Infection · 2026Article
- Interpreting antimicrobial resistance from bacterial whole-genome sequencing: prediction tools, database fragmentation, analytical trade-offs, and harmonized reporting.Frontiers in microbiology · 2026Review
- Comparison between cefepime and carbapenem therapy for deep-seated AmpC-producingAntimicrobial agents and chemotherapy · 2025Article
- Article
- Validation of Automated Bacterial Suspension Preparation by ColibriAntibiotics (Basel, Switzerland) · 2025Article
- Article
- Dilution susceptibility testing method evaluation for the combination of ceftibuten and avibactam against Enterobacterales.Journal of clinical microbiology · 2025Article
- Molecular and pharmacodynamic insights into β-lactam therapy for high-inoculumAntimicrobial agents and chemotherapy · 2025Article
- The combinations of cefazolin with linezolid and cefazolin with clindamycin are indifferent against methicillin-susceptibleMicrobiology spectrum · 2025Article
- Rapid direct disk diffusion testing for antibiotic resistance in urinary tract infections: a bacterial concentration-adjusted approach.Microbiology spectrum · 2025Article
- A biphasic metabolism-β-lactamase production landscape governs the inoculum effect in β-lactamase-expressingbioRxiv : the preprint server for biology · 2025Article
- Paradoxical carbapenemase activity detected by modified carbapenemase inactivation (mCIM) method inJournal of clinical microbiology · 2025Article
- Article
32 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
Abstract
The phenomenon of attenuated antibacterial activity at inocula above those utilized for susceptibility testing is referred to as the inoculum effect. Although the inoculum effect has been reported for several decades, it is currently debatable whether the inoculum effect is clinically significant. The aim of the present review was to consolidate currently available evidence to summarize which β-lactam drug classes demonstrate an inoculum effect against specific bacterial pathogens. Review of the literature showed that the majority of studies that evaluated the inoculum effect of β-lactams were in vitro investigations of Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Haemophilus influenzae and Staphylococcus aureus. Across all five pathogens, cephalosporins consistently displayed observable inoculum effects in vitro, whereas carbapenems were less susceptible to an inoculum effect. A handful of animal studies were available that validated that the in vitro inoculum effect translates into attenuated pharmacodynamics of β-lactams in vivo. Only a few clinical investigations were available and suggested that an in vitro inoculum effect of cefazolin against MSSA may correspond to an increased likeliness of adverse clinical outcomes in patients receiving cefazolin for bacteraemia. The presence of β-lactamase enzymes was the primary mechanism responsible for an inoculum effect, but the observation of an inoculum effect in multiple pathogens lacking β-lactamase enzymes indicates that there are likely multiple mechanisms that may result in an inoculum effect. Further clinical studies are needed to better define whether interventions made in the clinic in response to organisms displaying an in vitro inoculum effect will optimize clinical outcomes.
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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.