title: Infections of cefotaxime-resistant and cefmetazole-susceptible Escherichia coli and Klebsiella pneumoniae in children.
abstract: 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%.
authors.affiliation: Department of Pediatrics, Women's and Children's Hospital, Taipei, Taiwan.
authors.forename: Tsung Zu
authors.initials: TZ
authors.lastname: Wu
authors.forename: Po Ren
authors.initials: PR
authors.lastname: Hsueh
authors.forename: Luan Yin
authors.initials: LY
authors.lastname: Chang
authors.forename: Chun Yi
authors.initials: CY
authors.lastname: Lu
authors.forename: Chung Yi
authors.initials: CY
authors.lastname: Wang
authors.forename: Chin Ying
authors.initials: CY
authors.lastname: Yang
authors.forename: Pei Lan
authors.initials: PL
authors.lastname: Shao
authors.forename: Ping Ing
authors.initials: PI
authors.lastname: Lee
authors.forename: Chin Yun
authors.initials: CY
authors.lastname: Lee
authors.forename: Li Min
authors.initials: LM
authors.lastname: Huang
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D015311:Cefmetazole; D002439:Cefotaxime