Infections of cefotaxime-resistant and cefmetazole-susceptible Escherichia coli and Klebsiella pneumoniae in children.
A search of the computerized database at the National Taiwan University Hospital was made for cefotaxime-resistant and cefmetazole-susceptible isolates of Escherichia coli and Klebsiella pneumoniae (which may be extended-spectrum beta-lactamase-producing strains) in pediatric wards and intensive care units between 1999 and 2001. Fourteen infectious episodes attributed only to study bacteria were identified, including 7 episodes of bacteremia. Nine patients (64.3%) had underlying medical conditions: 3 were premature babies, 3 were immunodeficient, 2 had malignancy, and 2 had a congenital heart disease with active heart failure even after surgery. Among the 7 patients with bacteremias, 5 may be catheter-related; 6 were treated with carbapenems and 1 was treated with cefmetazole successfully, with or without the removal of the catheter. Before the acquisition of the infection, a history of stay in an intensive care unit within 4 weeks was noted in 10 cases (71.4%); a history of use of extended-spectrum cephalosporins within 4 weeks was also noted in 6 cases (42.9%). Cefmetazole, with or without an aminoglycoside, was clinically effective in 6 cases (42.8%). Except for 1 episode of pneumonia that ended in mortality, all of the infectious episodes were successfully treated. The mortality rate was 7.1%.
Wu
Tsung Zu
TZ
Department of Pediatrics, Women's and Children's Hospital, Taipei, Taiwan.
Hsueh
Po Ren
PR
Chang
Luan Yin
LY
Lu
Chun Yi
CY
Wang
Chung Yi
CY
Yang
Chin Ying
CY
Shao
Pei Lan
PL
Lee
Ping Ing
PI
Lee
Chin Yun
CY
Huang
Li Min
LM
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000382:microbiology; D015780:Carbapenems / Q000627:therapeutic use; D002404:Catheterization / Q000009:adverse effects; D015311:Cefmetazole / Q000494:pharmacology* / Q000627:therapeutic use; D002439:Cefotaxime / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000150:complications; D007223:Infant; D007297:Inpatients; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D008297:Male; D009369:Neoplasms / Q000150:complications; D047928:Premature Birth / Q000150:complications; D013624:Taiwan
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D015311:Cefmetazole; D002439:Cefotaxime