Antibacterial activity of piperacillin and tazobactam against beta-lactamase-producing clinical isolates

The effectiveness of a combination of the recently developed penam sulphone tazobactam with piperacillin was studied in clinical isolates with defined beta-lactamase production. The combination was highly effective against piperacillin-resistant beta-lactamase-producing Staphylococcus aureus, TEM-1-producing Escherichia coli and Proteus vulgaris isolates. It was less effective against E. coli isolates producing the OXA-1 enzyme and marginally active against TEM-1-producing Klebsiella spp. isolates. The presence of tazobactam at a concentration of 10 mg/l markedly reduced the minimal inhibitory concentrations for piperacillin in most of the beta-lactamase-derepressed Enterobacter cloacae, Serratia marcescens and Citrobacter freundii isolates; however, this synergism was much less pronounced in beta-lactamase-derepressed Klebsiella spp. isolates. The selection frequency of resistant clones from clinical E. cloacae and C. freundii isolates could be markedly reduced by the addition of 10 mg/l tazobactam to the piperacillin-containing selective medium. Resistant clones could be obtained only from part of the wild-type strains at 2 or 4 times the MIC of piperacillin in the presence of tazobactam, whereas resistant clones could be selected up to 64 times the MIC of piperacillin without the addition of tazobactam. This aspect deserves attention with respect to the rapid selection of beta-lactamase-derepressed clones from nosocomial pathogens.