Journal Article

Molecular Correlation for the Treatment Outcomes in Bloodstream Infections Caused by <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> with Reduced Susceptibility to Ceftazidime

Annie Wong-Beringer, Janet Hindler, Michael Loeloff, Anne Marie Queenan, Nancy Lee, David A. Pegues, John P. Quinn and Karen Bush

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 34, issue 2, pages 135-146
Published in print January 2002 | ISSN: 1058-4838
Published online January 2002 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/324742
Molecular Correlation for the Treatment Outcomes in Bloodstream Infections Caused by Escherichia coli and Klebsiella pneumoniae with Reduced Susceptibility to Ceftazidime

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Data are limited on outcomes of treatment with extended-spectrum cephalosporins (ESCs) for infections caused by Enterobacteriaceae that produce extended-spectrum β-lactamases (ESBLs). This study describes the largest treatment experience of a nonoutbreak series of bloodstream infections caused by strains of Escherichia coli (23 episodes) and Klebsiella pneumoniae (13 episodes) with a ceftazidime minimal inhibitory concentration of ⩾2 µg/mL. E. coli isolates produced a greater variety of β-lactamase types than did K. pneumoniae isolates, among which ESBL production was predominant. Five ESBL types were identified: TEM-12, TEM-71, TEM-6, SHV-12, and SHV-5. Most patients were treated empirically with an ESC-based regimen. A favorable response to treatment with a nonceftazidime ESC was observed when the causative pathogen produced either TEM-6 or TEM-12; ceftazidime treatment was associated with failure of therapy in all patients. Despite the limited clinical success, ESCs are currently not recommended for the treatment of serious infections caused by ESBL-producing strains.

Journal Article.  6638 words.  Illustrated.

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

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