STUDY OBJECTIVE: To evaluate the microbiologic and clinical outcomes of patients with extended-spectrum beta-lactamase (ESBL)-producing isolates over a 2-year period. DESIGN: Retrospective analysis. SETTING: Tertiary care teaching hospital. PATIENTS: Twenty-one patients with cultures of confirmed ESBL-producing Escherichia coli, Klebsiella pneumoniae, or Klebsiella oxytoca. MEASUREMENTS AND MAIN RESULTS: Antimicrobial susceptibilities of piperacillin-tazobactam, cefotetan, carbapenems, aminoglycosides, fluoroquinolones, trimethoprim-sulfamethoxazole, and nitrofurantoin (nitrofurantoin for urinary isolates only) of confirmed ESBL producers at our institution were determined, as well as clinical outcomes of patients with ESBL-producing isolates. Microbiologic and medical records were reviewed for patient sex and age, antimicrobial susceptibilities, antimicrobial therapy, and clinical and microbiologic outcomes. From January 2000-December 2001, 31 isolates were confirmed as ESBL producers (6 E. coli, 11 K. pneumoniae, and 14 K. oxytoca). A statistically significant increase occurred over the 2-year period from 9 (0.6%) of 1414 isolates in 2000 to 22 (1.8%) of 1218 isolates in 2001 (p = 0.0055). All isolates were susceptible to carbapenems, and more than 88% were susceptible to amikacin, cefotetan, or nitrofurantoin. Less than 70% of isolates were susceptible to gentamicin, fluoroquinolones, piperacillin-tazobactam, or trimethoprim-sulfamethoxazole. All patients treated with a carbapenem experienced clinical cure. Piperacillin-tazobactam alone and in combination resulted in an overall clinical cure rate of 55%, with a 50% cure rate for isolates susceptible to piperacillin-tazobactam. All patients in whom antibiotic therapy failed had been treated with piperacillin-tazobactam or cefepime, either alone or in combination with a fluoroquinolone. CONCLUSION: Carbapenems remain the treatment of choice for ESBL-producing pathogens. Piperacillin-tazobactam and cefepime should not be routinely administered for the treatment of these organisms.
STUDY OBJECTIVE: To evaluate the microbiologic and clinical outcomes of patients with extended-spectrum beta-lactamase (ESBL)-producing isolates over a 2-year period. DESIGN: Retrospective analysis. SETTING: Tertiary care teaching hospital. PATIENTS: Twenty-one patients with cultures of confirmed ESBL-producing Escherichia coli, Klebsiella pneumoniae, or Klebsiella oxytoca. MEASUREMENTS AND MAIN RESULTS: Antimicrobial susceptibilities of piperacillin-tazobactam, cefotetan, carbapenems, aminoglycosides, fluoroquinolones, trimethoprim-sulfamethoxazole, and nitrofurantoin (nitrofurantoin for urinary isolates only) of confirmed ESBL producers at our institution were determined, as well as clinical outcomes of patients with ESBL-producing isolates. Microbiologic and medical records were reviewed for patient sex and age, antimicrobial susceptibilities, antimicrobial therapy, and clinical and microbiologic outcomes. From January 2000-December 2001, 31 isolates were confirmed as ESBL producers (6 E. coli, 11 K. pneumoniae, and 14 K. oxytoca). A statistically significant increase occurred over the 2-year period from 9 (0.6%) of 1414 isolates in 2000 to 22 (1.8%) of 1218 isolates in 2001 (p = 0.0055). All isolates were susceptible to carbapenems, and more than 88% were susceptible to amikacin, cefotetan, or nitrofurantoin. Less than 70% of isolates were susceptible to gentamicin, fluoroquinolones, piperacillin-tazobactam, or trimethoprim-sulfamethoxazole. All patients treated with a carbapenem experienced clinical cure. Piperacillin-tazobactam alone and in combination resulted in an overall clinical cure rate of 55%, with a 50% cure rate for isolates susceptible to piperacillin-tazobactam. All patients in whom antibiotic therapy failed had been treated with piperacillin-tazobactam or cefepime, either alone or in combination with a fluoroquinolone. CONCLUSION:Carbapenems remain the treatment of choice for ESBL-producing pathogens. Piperacillin-tazobactam and cefepime should not be routinely administered for the treatment of these organisms.
Authors: Patrick J Gavin; Mira T Suseno; Richard B Thomson; J Michael Gaydos; Carl L Pierson; Diane C Halstead; Jaber Aslanzadeh; Stephen Brecher; Coleman Rotstein; Stephen E Brossette; Lance R Peterson Journal: Antimicrob Agents Chemother Date: 2006-06 Impact factor: 5.191
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Authors: Vikas P Chaubey; Johann Dd Pitout; Bruce Dalton; Terry Ross; Deirdre L Church; Daniel B Gregson; Kevin B Laupland Journal: BMC Res Notes Date: 2010-04-27
Authors: James S Lewis; Monica Herrera; Brian Wickes; Jan E Patterson; James H Jorgensen Journal: Antimicrob Agents Chemother Date: 2007-08-27 Impact factor: 5.191