Laura Escolà-Vergé1, Nieves Larrosa2, Ibai Los-Arcos3, Belen Viñado2, Juan José González-López2, Carles Pigrau3, Benito Almirante3, Oscar Len3. 1. Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: lescola@vhebron.net. 2. Microbiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain. 3. Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.
Abstract
BACKGROUND: OXA-48 is an Ambler class D β-lactamase that hydrolyses penicillin and imipenem but has poor hydrolytic activity against cephalosporins. However, very few clinical experiences of treating extended-spectrum β-lactamase (ESBL)-negative OXA-48 producers with cephalosporins have been published. OBJECTIVES: The aim of this study was to report clinical experience of infections due to ESBL-negative OXA-48-producing Klebsiella pneumoniae (K. pneumoniae) treated with cephalosporins. PATIENTS AND METHODS: A retrospective study was conducted at Vall d'Hebron University Hospital, in Barcelona (Spain). It reviewed all microbiological isolates of OXA-48-producers that did not co-produce ESBL from May 2014 to May 2017, and included only clinical strains of patients treated with a cephalosporin for ≥72h. RESULTS: From the 75 isolations of OXA-48 producers, there were 17 isolations of ESBL-negative OXA-48-producing K. pneumoniae. Three patients were treated with cephalosporins with successful outcomes: a pneumonia in a neutropenic patient treated with cefepime and amikacin; an acute focal nephritis of a renal graft treated with ceftriaxone; and an intrabdominal post-surgical infection treated with cefepime in combination with tigecycline at the beginning, and ciprofloxacin afterwards. CONCLUSIONS: Cephalosporins could be an alternative treatment in selected patients with ESBL-negative OXA-48-producing K. pneumoniae infections, especially to avoid carbapenem use. However, it remains unknown if they should be given in combination.
BACKGROUND: OXA-48 is an Ambler class D β-lactamase that hydrolyses penicillin and imipenem but has poor hydrolytic activity against cephalosporins. However, very few clinical experiences of treating extended-spectrum β-lactamase (ESBL)-negative OXA-48 producers with cephalosporins have been published. OBJECTIVES: The aim of this study was to report clinical experience of infections due to ESBL-negative OXA-48-producing Klebsiella pneumoniae (K. pneumoniae) treated with cephalosporins. PATIENTS AND METHODS: A retrospective study was conducted at Vall d'Hebron University Hospital, in Barcelona (Spain). It reviewed all microbiological isolates of OXA-48-producers that did not co-produce ESBL from May 2014 to May 2017, and included only clinical strains of patients treated with a cephalosporin for ≥72h. RESULTS: From the 75 isolations of OXA-48 producers, there were 17 isolations of ESBL-negative OXA-48-producing K. pneumoniae. Three patients were treated with cephalosporins with successful outcomes: a pneumonia in a neutropenicpatient treated with cefepime and amikacin; an acute focal nephritis of a renal graft treated with ceftriaxone; and an intrabdominal post-surgical infection treated with cefepime in combination with tigecycline at the beginning, and ciprofloxacin afterwards. CONCLUSIONS:Cephalosporins could be an alternative treatment in selected patients with ESBL-negative OXA-48-producing K. pneumoniae infections, especially to avoid carbapenem use. However, it remains unknown if they should be given in combination.
Authors: Jodie C Hamrick; Jean-Denis Docquier; Tsuyoshi Uehara; Cullen L Myers; David A Six; Cassandra L Chatwin; Kaitlyn J John; Salvador F Vernacchio; Susan M Cusick; Robert E L Trout; Cecilia Pozzi; Filomena De Luca; Manuela Benvenuti; Stefano Mangani; Bin Liu; Randy W Jackson; Greg Moeck; Luigi Xerri; Christopher J Burns; Daniel C Pevear; Denis M Daigle Journal: Antimicrob Agents Chemother Date: 2020-02-21 Impact factor: 5.191
Authors: William M McGee; Arvind Verma; Marjaana Viirtola; Scott R Kronewitter; Jason R Neil; James L Stephenson Journal: J Mass Spectrom Adv Clin Lab Date: 2021-05-29