Infect Chemother.  2004 Jun;36(3):127-131.

Failure of Cephalosporin Treatment for Bloodstream Infection Caused by Apparently Susceptible Klebsiella pneumoniae which Produced DHA-1 beta-Lactamase Induced by Clavulanic Acid

Affiliations
  • 1Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea. mdohmd@snu.ac.kr
  • 2Department of Laboratory Medicine, College of Medicine, Seoul National University, Seoul, Korea.
  • 3Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
  • 4Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND: The therapeutic option is limited for the infections caused by organisms producing plasmid- mediated AmpC beta-lactamases, increasingly identified worldwide. Two sporadic patients with bacteremia caused by K. pneumoniae possessing an unusual inducible beta-lactam resistant phenotype were found in a university hospital.
RESULTS
We conducted antibiotic susceptibility test according to NCCLS guideline. Also, we characterized beta-lactamase by isoelectric focusing.
RESULTS
DHA-1 gene conferred the resistant phenotype. The patients had experienced treatment failure when treated with extended-spectrum cephalosporin. For the isolates the cephalosporin resistance was induced by clavulanic acid (and cefoxitin).
CONCLUSION
Theses results suggest that the extended-spectrum cephalosporins might not provide optimal therapeutic option for inducible DHA-1-producing K. pneumoniae infection, even when the pathogens are susceptible in vitro.

Keyword

Klebsiella; beta-lactamase; Cephalosporin resistance

MeSH Terms

Bacteremia
beta-Lactamases*
Cephalosporin Resistance
Cephalosporins
Clavulanic Acid*
Humans
Isoelectric Focusing
Klebsiella pneumoniae*
Klebsiella*
Phenotype
Pneumonia
Treatment Failure
Cephalosporins
Clavulanic Acid
beta-Lactamases
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