Treatment failure due to extended spectrum βlactamase

Karas, J. A.; Pillay, D.; Muckart, D. J. J.; Sturm, A. W.

doi:10.1093/jac/37.1.203

Cited by 103 publications

(74 citation statements)

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“…The clinical details of 26 patients previously reported (2,4,8,15,17,18,19,21,22,23,28) are reported in Table 3. When the data for the 10 patients from the international K. pneumoniae bacteremia study were combined with those for the 26 previously reported patients, data for a total of 36 patients were available for analysis.…”

Section: Resultsmentioning

confidence: 99%

Outcome of Cephalosporin Treatment for Serious Infections Due to Apparently Susceptible Organisms Producing Extended-Spectrum β-Lactamases: Implications for the Clinical Microbiology Laboratory

et al. 2001

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Although extended-spectrum beta-lactamases (ESBLs) hydrolyze cephalosporin antibiotics, some ESBLproducing organisms are not resistant to all cephalosporins when tested in vitro. Some authors have suggested that screening klebsiellae or Escherichia coli for ESBL production is not clinically necessary, and when most recently surveyed the majority of American clinical microbiology laboratories did not make efforts to detect ESBLs. We performed a prospective, multinational study of Klebsiella pneumoniae bacteremia and identified 10 patients who were treated for ESBL-producing K. pneumoniae bacteremia with cephalosporins and whose infecting organisms were not resistant in vitro to the utilized cephalosporin. In addition, we reviewed 26 similar cases of severe infections which had previously been reported. Of these 36 patients, 4 had to be excluded from analysis. Of the remaining 32 patients, 100% (4 of 4) patients experienced clinical failure when MICs of the cephalosporin used for treatment were in the intermediate range and 54% (15 of 28) experienced failure when MICs of the cephalosporin used for treatment were in the susceptible range. Thus, it is clinically important to detect ESBL production by klebsiellae or E. coli even when cephalosporin MICs are in the susceptible range (< 8 g/ml) and to report ESBL-producing organisms as resistant to aztreonam and all cephalosporins (with the exception of cephamycins).

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Section: Resultsmentioning

confidence: 99%

Outcome of Cephalosporin Treatment for Serious Infections Due to Apparently Susceptible Organisms Producing Extended-Spectrum β-Lactamases: Implications for the Clinical Microbiology Laboratory

et al. 2001

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“…Etest confirmatory strips are convenient but expensive and yield more inconclusive results than CLSI tests due to a more restricted concentration range (11,40). Until proven otherwise, confirmed ESBL-producing isolates should be reported as resistant to all penicillins, cephalosporins, and aztreonam (8) to avoid therapy with antibiotics that may be clinically ineffective (6,20,32,38). This recommendation should apply to all ESBL-producing isolates irrespective of species.…”

Section: Manual Confirmatory Testsmentioning

confidence: 99%

“…It is based on limited therapeutic outcome data (3,31), pharmacokinetic/pharmacodynamic data (3), and the concept that the lower the cephalosporin MIC the greater the likelihood of successful therapy (3,19,31). At variance with this approach, there are reports of therapeutic failures with cefepime associated with MICs of Յ2 g/ml (31) and 4 g/ml in a pediatric patient (3) and with a cefotaxime MIC of 0.75 g/ml (20). There is also the concern that instead of the simplicity of cephalosporin and aztreonam susceptibility results being automatically changed to resistant for positive isolates, labs face the impossible task of having to overcome the inherent variability of testing ESBL-labile drugs to provide precise and accurate results.…”

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confidence: 99%

Extended-Spectrum-β-Lactamase, AmpC, and Carbapenemase Issues

2010

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“…Highly revealing studies performed in the United States and Europe by Tenover et al, and Livermore et al, respectively, reported that errors in the detection of ESBL mediated resistance are frequently encountered with both automated and disk diffusion methods [8,24]. It might be due to the variable affinity of enzymes for different substrates and inoculums effect [26]. It is also documented that ESBL-producing organism with third-generation cephalosporins may result in clinical failure if the infection is outside the urinary tract [25].…”

Section: Discussionmentioning

confidence: 99%

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2014

ADT

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Background: Extended Spectrum β-lactamases (ESBLs) are rapidly evolving group of β-lactamase enzymes produced by the gram-negative bacteria which is very important to detect in clinical laboratory for effective treatment. The aim of the present study was to see the ESBL genes among Third Generation Cephalosporins (3GCs) sensitive bacterial strains. Methods:This cross sectional study was undertaken in non-repetitive clinical isolates collected from Mymnesingh Medical College Hospital, Mymensingh, Bangladesh from both the outpatient and inpatient departments over a period of six months from January 2011 to June 2011. The ESBL status was confirmed by double disc diffusion test and minimum inhibitory concentration by agar dilution method as recommended by Clinical and Laboratory Standard Institute 2010 and multiplex polymerase chain reaction for TEM, SHV and CTX-M genes.Results: A total of 300 Gram negative bacilli were included in the study; among them 236 were resistant and 64 were sensitive to 3GCs by disc diffusion test. Multidrug resistant ESBL production was found 75.8% from resistant isolates and 54.6% from sensitive isolates. Rate of TEM, SHV and CTX-M genes present among sensitive strains were 36.4%, 24.2% and 21.1%, respectively. Conclusion:Both common and new ESBLs genes were detected from 3GCs sensitive bacteria of which TEM is most common. Routine ESBLs screening for all Gram-negative isolates both from sensitive and resistant to 3GCs strains might be useful for the physicians in selecting effective antibiotics.

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Treatment failure due to extended spectrum βlactamase

Cited by 103 publications

References 0 publications

Outcome of Cephalosporin Treatment for Serious Infections Due to Apparently Susceptible Organisms Producing Extended-Spectrum β-Lactamases: Implications for the Clinical Microbiology Laboratory

Outcome of Cephalosporin Treatment for Serious Infections Due to Apparently Susceptible Organisms Producing Extended-Spectrum β-Lactamases: Implications for the Clinical Microbiology Laboratory

Extended-Spectrum-β-Lactamase, AmpC, and Carbapenemase Issues

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