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Clinical and microbiologic analysis of a hospital's extended-spectrum beta-lactamase-producing isolates over a 2-year period.

Abstract：

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.

journal_name

Pharmacotherapy

journal_title

Pharmacotherapy

authors

Burgess DS,Hall RG 2nd,Lewis JS 2nd,Jorgensen JH,Patterson JE

doi

10.1592/phco.23.12.1232.32706

subject

Has Abstract

pub_date

2003-10-01 00:00:00

pages

1232-7

issue

eissn

0277-0008

issn

1875-9114

journal_volume

pub_type

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Clinical and microbiologic analysis of a hospital's extended-spectrum beta-lactamase-producing isolates over a 2-year period.