| Summary: | The increasing prevalence of extended-spectrum β-lactamase (ESBL)-producing <i>Enterobacteriaceae</i> has greatly affected the clinical efficacy of β-lactam antibiotics in the management of urinary tract infections (UTIs). The limited treatment options have resulted in the increased use of carbapenem. However, flomoxef could be a potential carbapenem-sparing strategy for UTIs caused by ESBL-producers. Here, we compared the in vitro susceptibility of UTI-associated ESBL-producers to flomoxef and established β-lactam antibiotics. Fifty <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> strains isolated from urine samples were subjected to broth microdilution assay, and the presence of ESBL genes was detected by polymerase chain reactions. High rates of resistance to amoxicillin-clavulanate (76–80%), ticarcillin-clavulanate (58–76%), and piperacillin-tazobactam (48–50%) were observed, indicated by high minimum inhibitory concentration (MIC) values (32 µg/mL to 128 µg/mL) for both species. The ESBL genes <i>bla</i><sub>CTX-M</sub> and <i>bla</i><sub>TEM</sub> were detected in both <i>E. coli</i> (58% and 54%, respectively) and <i>K. pneumoniae</i> (88% and 74%, respectively), whereas <i>bla</i><sub>SHV</sub> was found only in <i>K. pneumoniae</i> (94%). Carbapenems remained as the most effective antibiotics against ESBL-producing <i>E. coli</i> and <i>K. pneumoniae</i> associated with UTIs, followed by flomoxef and cephamycins. In conclusion, flomoxef may be a potential alternative to carbapenem for UTIs caused by ESBL-producers in Malaysia.
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