PATERSON DL, KO W, MULAZIMOGLU L, CASELLAS JM, GOOSSENS H, TRENHOLME GM, KLUGMAN KP, YU VL; Interscience Conference on Antimicrobial Agents and Chemotherapy.

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1999 Sep 26-29; 39: 180 (abstract no. 2266).

Infectious Disease Section, VA Med. Ctr., Pittsburgh, PA

Presbyterian St Lukes Med. Ctr., Chicago, IL; [7]South African Inst. of Med. Res., Johannesburg, SOUTH AFRICA.BACKGROUND: The last 5 years have seen an increase in ciprofloxacin resistance (Cipro-R) in K. pneumoniae and even the arrival of plasmid-mediated Cipro-R in this organism. Yet the epidemiology of Cipro-R in Klebsiella has never been studied.METHODS: A prospective, multicountry study on the epidemiology of antibiotic resistance in 455 episodes of blood culture + K. pneumoniae infections was performed. 25 Cipro-R and 427 ciprofloxacin-susceptible (Cipro-S) K. pneumoniae cases were compared (cases with intermediate MICs were excluded).RESULTS: Cipro-R occurred in 5.5% (25/452) K. pneumoniae isolates. 48% (12/ 25) isolates had ciprofloxacin MICs > 32 microg/mL. Rates of Cipro-R in each country were: 42% Turkey, 15% Argentina, 9% United States and 6% Taiwan. No Cipro-R isolates were found in South Africa, Belgium or Australia. 72% of cases of Cipro-R were nosocomially acquired vs. 54% with Cipro-S infections (p=0.08). 8% of cases of Cipro-R were admitted from nursing homes vs. 3% with Cipro-S infections (p=0.14). In univariate analysis, risk factors for ciprofloxacin resistance were: presence of a urinary catheter (p=0.0095), receipt of a quinolone (p=0.0008) or 3rd generation cephalosporin (p=0.006) in the 2 weeks before bacteremia, being a transplant recipient (p=0.06) or having chronic liver disease (p=0.10). Extended-spectrum beta-lactamase (ESBL) production was detected in 60% (15/25) isolates of Cipro-R vs. 16% (68/427) Cipro-S K. pneumoniae (p=0.0001). Multivariate analysis showed that prior receipt of a quinolone (p=0.0065) and having an ESBL-producing strain (p=0.01) were the most important predictors of Cipro-R. Only 3/15 patients with a Cipro-R, ESBL+ isolate had recently received a quinolone. Overall 14 day mortality was 16% in patients with Cipro-R infections.CONCLUSIONS: Ciprofloxacin resistance is frequently associated with ESBL production in bacteremic K. pneumoniae isolates, necessitating a close examination of the mechanism of their coexistence.

Publication Types:

• Meeting Abstracts

Keywords:

• Argentina
• Australia
• Bacteremia
• Belgium
• Chicago
• Ciprofloxacin
• Humans
• Klebsiella Infections
• Klebsiella pneumoniae
• Microbial Sensitivity Tests
• Prospective Studies
• Risk Factors
• South Africa
• Taiwan
• Turkey
• United States
• beta-Lactamases
• epidemiology

Other ID:

• GWAIDS0007615

UI: 102245111

From Meeting Abstracts