Epidemiology of ciprofloxacin resistance and its relationship to extended-spectrum beta-lactamase production in Klebsiella pneumoniae isolates causing bacteremia.
A prospective study of Klebsiella pneumoniae bacteremia was performed in 12 hospitals in 7 countries. Of 452 episodes of bacteremia, 25 (5.5%) were caused by K. pneumoniae that was resistant in vitro to ciprofloxacin. Extended-spectrum beta-lactamase (ESBL) production was detected in 15 (60%) of 25 ciprofloxacin-resistant isolates, compared with 68 (16%) of 427 ciprofloxacin-susceptible strains (P=.0001). Multivariate analysis revealed that risk factors for ciprofloxacin resistance in K. pneumoniae included prior receipt of a quinolone (P=.0065) and an ESBL-producing strain (P=.012). In all, 18% of ESBL-producing isolates were also ciprofloxacin-resistant. Pulsed-field gel electrophoresis showed that 11 of the 15 ciprofloxacin-resistant ESBL-producing strains belonged to just 4 genotypes, suggesting that patient-to-patient transmission of such strains occurred. The close relationship between ESBL production and ciprofloxacin resistance is particularly worrisome because the first reported instance of plasmid-mediated ciprofloxacin resistance has been in an isolate of K. pneumoniae also possessing an ESBL.
Paterson
D L
DL
Infectious Disease Section, Veterans Affairs Medical Center, Pittsburgh, PA 15240, USA.
Mulazimoglu
L
L
Casellas
J M
JM
Ko
W C
WC
Goossens
H
H
Von Gottberg
A
A
Mohapatra
S
S
Trenholme
G M
GM
Klugman
K P
KP
McCormack
J G
JG
Yu
V L
VL
D000890:Anti-Infective Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002939:Ciprofloxacin / Q000494:pharmacology*; D003428:Cross Infection / Q000382:microbiology; D004352:Drug Resistance, Microbial / Q000235:genetics; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics
D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D001618:beta-Lactamases