Failure of ceftazidime-amikacin therapy for bacteremia and meningitis due to Klebsiella pneumoniae producing an extended-spectrum beta-lactamase.
A multiple trauma patient failed treatment with ceftazidime and amikacin for bacteremia and meningitis due to a Klebsiella pneumoniae strain that produced a novel, plasmid-mediated beta-lactamase. Both pre- and posttreatment isolates were resistant to ceftazidime (MIC, greater than or equal to 64 micrograms/ml) and various penicillins but not to other expanded-spectrum cephalosporins. The beta-lactamase had a pI of 5.25 and was encoded on a conjugal plasmid of approximately 150 kilobases. DNA hybridization studies indicated that the enzyme was a TEM derivative.
Infectious Disease Service, Brooke Army Medical Center, Fort Sam Houston, Texas 78234.
C E
CE
Smith
B S
BS
Tillman
A W
AW
Howell
R N
RN
Longfield
J H
JH
Jorgensen
D000328:Adult; D000583:Amikacin / Q000627:therapeutic use*; D015139:Blotting, Southern; D002442:Ceftazidime / Q000627:therapeutic use*; D004269:DNA, Bacterial / Q000302:isolation & purification; D004352:Drug Resistance, Microbial / Q000235:genetics; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000209:etiology; D007711:Klebsiella pneumoniae / Q000201:enzymology; D008297:Male; D008581:Meningitis / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D018805:Sepsis / Q000188:drug therapy* / Q000209:etiology; D014947:Wounds and Injuries / Q000150:complications; D001618:beta-Lactamases / Q000096:biosynthesis
D004269:DNA, Bacterial; D000583:Amikacin; D002442:Ceftazidime; D001618:beta-Lactamases