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Table 3 (Adapted from [14, 15]) usual breakpoints and susceptibility of ESBL-producing Enterobacteriaceae

From: Piperacillin–tazobactam as alternative to carbapenems for ICU patients

  Susceptibility (%) Breakpoints (mg/L) Ecological impact Comments
Third-generation cephalosporins Escherichia coli: < 10%
Klebsiella species: 3%
EUCAST: S ≤ 1
CLSI: S ≤ 1
+++ Only for targeted therapy or de-escalation
MIC required
Cefepime E. coli: 5–30%
K. pneumoniae: 5–60%
EUCAST: S < 1
CLSI: S ≤ 2
+++ Frequent failure if MICs > 1 mg/L
MIC required
Cefoxitin E. coli: 80% EUCAST: NA ++ PK optimization
Ceftolozane–tazobactam E. coli: 85–95%
K. pneumoniae: 40–65%
EUCAST: S ≤ 1
CLSI: S ≤ 8
?  
Ceftazidime–avibactam E. coli: 98–100%
K. pneumoniae: 90–100%
EUCAST: S ≤ 8
CLSI: S ≤ 8
? Probably as effective as carbapenems
Temocillin E. coli 61% (CMI ≤ 8)
E. coli 99% (CMI ≤ 32)
EUCAST: S ≤ 8
EUCAST: S ≤ 32 (urinary)
CLSI: S ≤ 8
CLSI: S ≤ 32 (urinary)
± PK optimization (high dosage and prolonged infusion)
  1. CLSI Clinical and Laboratory Standard Institute, EUCAST European Committee on Antimicrobial Susceptibility Testing, MIC minimum inhibitory concentration, NA not applicable, PK pharmacokinetic, VAP ventilator-associated pneumonia