Infections by OXA-48-like-producing Klebsiella pneumoniae non-co-producing extended-spectrum beta-lactamase: Can they be successfully treated with cephalosporins?

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.

authors

Escolà-Vergé L,Larrosa N,Los-Arcos I,Viñado B,González-López JJ,Pigrau C,Almirante B,Len O

doi

10.1016/j.jgar.2019.02.016

subject

Has Abstract

pub_date

2019-12-01 00:00:00

pages

28-31

eissn

2213-7165

issn

2213-7173

pii

S2213-7165(19)30056-6

journal_volume

19

pub_type

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