title: Epidemiology of ciprofloxacin resistance and its relationship to extended-spectrum beta-lactamase production in Klebsiella pneumoniae isolates causing bacteremia.
abstract: 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.
authors.affiliation: Infectious Disease Section, Veterans Affairs Medical Center, Pittsburgh, PA 15240, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Paterson
authors.forename: L
authors.initials: L
authors.lastname: Mulazimoglu
authors.forename: J M
authors.initials: JM
authors.lastname: Casellas
authors.forename: W C
authors.initials: WC
authors.lastname: Ko
authors.forename: H
authors.initials: H
authors.lastname: Goossens
authors.forename: A
authors.initials: A
authors.lastname: Von Gottberg
authors.forename: S
authors.initials: S
authors.lastname: Mohapatra
authors.forename: G M
authors.initials: GM
authors.lastname: Trenholme
authors.forename: K P
authors.initials: KP
authors.lastname: Klugman
authors.forename: J G
authors.initials: JG
authors.lastname: McCormack
authors.forename: V L
authors.initials: VL
authors.lastname: Yu
mesh_terms: 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
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D001618:beta-Lactamases