Journal Article

Epidemiology of Ciprofloxacin Resistance and Its Relationship to Extended-Spectrum β-Lactamase Production in <i>Klebsiella pneumoniae</i> Isolates Causing Bacteremia

David L. Paterson, Lutfiye Mulazimoglu, Jose Maria Casellas, Wen-Chien Ko, Herman Goossens, Anne Von Gottberg, Sunita Mohapatra, Gordon M. Trenholme, Keith P. Klugman, Joseph G. McCormack and Victor L. Yu

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 30, issue 3, pages 473-478
Published in print March 2000 | ISSN: 1058-4838
Published online March 2000 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/313719
Epidemiology of Ciprofloxacin Resistance and Its Relationship to Extended-Spectrum β-Lactamase Production in Klebsiella pneumoniae Isolates Causing Bacteremia

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A prospective study of Klebsiella pneumoniae bacteremia was performed in 12 hospitals in 7 countries. Of 452 episodes of bacteremia, 25 (5.5%) were caused by K. pneumoniae that was resistant in vitro to ciprofloxacin. Extended-spectrum β-lactamase (ESBL) production was detected in 15 (60%) of 25 ciprofloxacin-resistant isolates, compared with 68 (16%) of 427 ciprofloxacin-susceptible strains (P = .0001). Multivariate analysis revealed that risk factors for ciprofloxacin resistance in K. pneumoniae included prior receipt of a quinolone (P = .0065) and an ESBL-producing strain (P = .012). In all, 18% of ESBL-producing isolates were also ciprofloxacin-resistant. Pulsed-field gel electrophoresis showed that 11 of the 15 ciprofloxacin-resistant ESBL-producing strains belonged to just 4 genotypes, suggesting that patient-to-patient transmission of such strains occurred. The close relationship between ESBL production and ciprofloxacin resistance is particularly worrisome because the first reported instance of plasmid-mediated ciprofloxacin resistance has been in an isolate of K. pneumoniae also possessing an ESBL.

Journal Article.  3844 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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