Clinical implications of extended-spectrum β-lactamase-producing Klebsiella pneumoniae bacteraemia

Kim, Bohyoung; Woo, Jun Hee; Kim, M.-N; Ryu, Jin‐Sook; Kim, Y.S

doi:10.1053/jhin.2002.1288

Cited by 106 publications

(75 citation statements)

References 30 publications

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“…Among carbapenems, particularly for severe infections, many clinicians prefer to use a group 2 carbapenem rather than ertapenem (25). In this large cohort of patients with ESBL BSIs, carbapenems were associated with significantly better clinical outcomes than other antimicrobial classes, a result which is similar to findings of other investigators (8,12,17,19,21,24,31). Of particular interest, ertapenem was as effective as group 2 carbapenems in the treatment of ESBL BSIs.…”

supporting

confidence: 78%

“…No prospective, randomized, controlled trials have been conducted analyzing the preferred therapeutic management of ESBL-producing Enterobacteriaceae infections. Few small retrospective trials have demonstrated the relative superiority of carbapenems over other agents (4,8,12,14,17,19,21,24,31). The carbapenems that were studied were group 2 carbapenems (e.g., imipenem and meropenem).…”

mentioning

confidence: 99%

“…There are no strict guidelines or policies pertaining to the preferred therapeutic management of infections due to ESBL-producing Enterobacteriaceae, although many consider carbapenems the preferred agents (1,4,8,12,14,17,19,21,24,31). Among carbapenems, particularly for severe infections, many clinicians prefer to use a group 2 carbapenem rather than ertapenem (25).…”

mentioning

confidence: 99%

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Efficacy of Ertapenem for Treatment of Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae

Collins

Marchaim

Pogue

et al. 2012

Antimicrob Agents Chemother

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e Ertapenem is active against extended-spectrum-␤-lactamase (ESBL)-producing Enterobacteriaceae organisms but inactive against Pseudomonas aeruginosa and Acinetobacter baumannii. Due to a lack of therapeutic data for ertapenem in the treatment of ESBL bloodstream infections (BSIs), group 2 carbapenems (e.g., imipenem or meropenem) are often preferred for treatment of ESBL-producing Enterobacteriaceae, although their antipseudomonal activity is unnecessary. From 2005 to 2010, 261 patients with ESBL BSIs were analyzed. Outcomes were equivalent between patients treated with ertapenem and those treated with group 2 carbapenems (mortality rates of 6% and 18%, respectively; P ‫؍‬ 0.18).

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supporting

confidence: 78%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Efficacy of Ertapenem for Treatment of Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae

Collins

Marchaim

Pogue

et al. 2012

Antimicrob Agents Chemother

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“…Several studies have found a relationship between third-generation cephalosporin use and acquisition of an ESBL-producing strain (16,19,116,126,164,193,196,205,210,291,302,358). Other studies, which were underpowered to show statistical significance, showed trends towards such an association (the P values in all three studies were between 0.05 and 0.10) (103,299,419).…”

Section: Risk Factors For Colonization and Infection With Esbl Producersmentioning

confidence: 95%

Extended-Spectrum β-Lactamases: a Clinical Update

2005

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SUMMARY Extended-spectrum β-lactamases (ESBLs) are a rapidly evolving group of β-lactamases which share the ability to hydrolyze third-generation cephalosporins and aztreonam yet are inhibited by clavulanic acid. Typically, they derive from genes for TEM-1, TEM-2, or SHV-1 by mutations that alter the amino acid configuration around the active site of these β-lactamases. This extends the spectrum of β-lactam antibiotics susceptible to hydrolysis by these enzymes. An increasing number of ESBLs not of TEM or SHV lineage have recently been described. The presence of ESBLs carries tremendous clinical significance. The ESBLs are frequently plasmid encoded. Plasmids responsible for ESBL production frequently carry genes encoding resistance to other drug classes (for example, aminoglycosides). Therefore, antibiotic options in the treatment of ESBL-producing organisms are extremely limited. Carbapenems are the treatment of choice for serious infections due to ESBL-producing organisms, yet carbapenem-resistant isolates have recently been reported. ESBL-producing organisms may appear susceptible to some extended-spectrum cephalosporins. However, treatment with such antibiotics has been associated with high failure rates. There is substantial debate as to the optimal method to prevent this occurrence. It has been proposed that cephalosporin breakpoints for the Enterobacteriaceae should be altered so that the need for ESBL detection would be obviated. At present, however, organizations such as the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards) provide guidelines for the detection of ESBLs in klebsiellae and Escherichia coli. In common to all ESBL detection methods is the general principle that the activity of extended-spectrum cephalosporins against ESBL-producing organisms will be enhanced by the presence of clavulanic acid. ESBLs represent an impressive example of the ability of gram-negative bacteria to develop new antibiotic resistance mechanisms in the face of the introduction of new antimicrobial agents.

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“…Risk factors associated with ESBL production include: prolonged hospital or intensive care unit stay, prior hospitalization (BISSON et al, 2002), multiple courses of antimicrobial therapy particularly extended-spectrum cephalosporin (LUCET et al, 1996;LAUTENBACH et al, 2001). Additional risks involve: indwelling devices as central venous and urinary catheters (LUCET et al, 1996;KIM et al, 2002); intubation and assisted mechanical ventilation (LIN et al, 2003) and severe underlying disease as malignancy and heart failure (HO et al, 2002). The degree of resistance to third-generation cephalosporins can be highly variable.…”

Section: Introductionmentioning

confidence: 99%

Métodos de triagem e de confirmação para detecção de BLEAs (beta lactamases de espectro ampliados) em isolados de Klebsiella pneumoniae

Vespero¹,

Perugini²,

Saridakis³

2007

Semin. Cienc. Biol. Saude

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ESBLs (extended-spectrum ß-lactamases) are enzymes produced by Enterobacteriaceae, especially Klebsiella pneumoniae, which mediate resistance to extended-spectrum ß-lactams and aztreonam. Considering the importance of detecting ESBLs producing strains, in this study, usual screening and confirmatory assays were compared. One hundred and seven strains of K. pneumoniae, isolated from patients with urinary tract infection, were screened for ESBLs production according to NCCLS 2005 guidelines, using broth microdilution in the Microscan Walkaway (Dade Behering) and Kirby-Bauer disk diffusion (KBD) test. Fifty-five strains selected as possible ESBL producers (51,4%), were submitted to confirmatory assays: E-test, double disk (DD) approximation and clavulanic acid (CA) association. Production of ESBLs was detected by the five methods used in 38 (69%) strains and 10 (18,2%) were negative only in DD. Seven strains (12,7%) did not present suggestive breakpoints in the Microscan Walkaway and were negative in the DD test, whereas the KBD values for the same strains obtained were indicative of ESBLs production. These results suggest that the combination of KBD breakpoints determination and CA association can be used as an efficient, alternative and less expensive system than the E-test. Key words: K .pneumoniae. Extended-spectrum ß-lactamases (ESBLs). Screening. ResumoBLEAs (ß-lactamases de espectro estendido) são enzimas produzidas por várias espécies de Enterobacteriaceae, principalmente Klebsiella pneumoniae, as quais conferem resistência aos ß-lactâmicos de espectro ampliado e aztreonam. Considerando a importância da detecção de BLEAs, neste estudo foram comparados métodos de triagem e de confirmação. As 107 amostras de K. pneumoniae, isoladas de pacientes com infecção urinária foram triadas quanto à produção de BLEAs, segundo normas do NCCLS 2005, utilizando microdiluição em caldo no Microscan Walkaway e teste de disco difusão de Kirby-Bauer (KBD). As 55 cepas selecionadas foram submetidas a ensaios de confirmação como possíveis produtoras de BLEAs (51,4%): E-test, aproximação com discos duplos (DD) e associação com ácido clavulânico (CA). A produção de BLEAs foi detectada pelos cinco métodos em 38 (69%) amostras e 10 amostras (18,2%) foram negativas para o teste DD. Sete amostras (12,7%) não apresentaram valores sugestivos no método automatizado e também foram negativos no teste de DD, mas os valores dos halos no teste de KBD foram indicativos da produção de BLEAs. Estes resultados sugerem que o uso combinado do método KBD e associação com CA podem ser utilizados como um sistema alternativo eficiente e menos dispendioso que o E-test. Palavras-chave: K.pneumoniae. Beta-lactamases de espectro ampliado (BLEAs). Triagem.

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Clinical implications of extended-spectrum β-lactamase-producing Klebsiella pneumoniae bacteraemia

Cited by 106 publications

References 30 publications

Efficacy of Ertapenem for Treatment of Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae

Efficacy of Ertapenem for Treatment of Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae

Extended-Spectrum β-Lactamases: a Clinical Update

Métodos de triagem e de confirmação para detecção de BLEAs (beta lactamases de espectro ampliados) em isolados de Klebsiella pneumoniae

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