title: Antibiotic-resistance patterns and frequency of extended-spectrum beta-lactamase-producing isolates of Klebsiella pneumoniae in Tehran.
abstract: BACKGROUND
  Extended-spectrum beta-lactamase (ESBL)-producing strains of Klebsiella pneumoniae have caused major therapeutic problems worldwide since the majority are resistant to various antibiotics. In this study, an investigation was conducted regarding antibiotic-resistant patterns of 128 isolates of K pneumonile cultured from Iranian patients at two teaching hospitals during 2004-2005.
  
  
  METHODS
  The susceptibility of isolates to 21 antimicrobial agents was determined using the disk diffusion method. Disks containing ceftazidime, cefotaxime, ceftazidime/clavulanic acid, and cefotaxime/clavulanic acid were used in the phenotypic confirmatory (PCT) method to detect ESBL isolates. A comparison between the confirmatory method and double-disk synergy test (aztreonam, ceftazidime, ceftriaxone, cefotaxime, and amoxicillin/clavulanic acid) was also made to assign the appropriate method of detection for ESBLs. The E-test was used to determine the susceptibility of isolates to cefepime.
  
  
  RESULTS
  All strains were susceptible to imipenem and meropenem. Resistance to ciprofloxacin and gentamicin were found in 37% (n=47) and 33% (n=42) of isolates, respectively. Production of ESBL was detected in 44.5% of isolates. Resistance to cefepime was found in 40% of isolates.
  
  
  CONCLUSIONS
  The prevalence of ESBL strains in the study hospitals is high. The double-disk synergy method is not preferable in successfully detecting ESBL strains. More importantly, 33% of ESBL strains were also resistant to ciprofloxacin and aminoglycosides. Based on the laboratory results, it is recommended that prescription of cephalosporins be restricted to susceptible isolates and that the usage of other effective antibiotics be considered.
authors.affiliation: Department of Microbiology, School of Medicine, Tehran University of Medical Science, Tehran, Iran. mfeizabadi@tums.ac.ir
authors.forename: Mohammad Mehdi
authors.initials: MM
authors.lastname: Feizabadi
authors.forename: Gelavizh
authors.initials: G
authors.lastname: Etemadi
authors.forename: Davood
authors.initials: D
authors.lastname: Yadegarinia
authors.forename: Marveh
authors.initials: M
authors.lastname: Rahmati
authors.forename: Shiveh
authors.initials: S
authors.lastname: Shabanpoor
authors.forename: Saeed
authors.initials: S
authors.lastname: Bokaei
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D000077723:Cefepime; D002511:Cephalosporins / Q000494:pharmacology; D002939:Ciprofloxacin / Q000494:pharmacology; D004353:Drug Evaluation, Preclinical; D024881:Drug Resistance, Bacterial; D005260:Female; D005839:Gentamicins / Q000494:pharmacology; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D007492:Iran; D007711:Klebsiella pneumoniae / Q000378:metabolism*; D008297:Male; D000077731:Meropenem; D013845:Thienamycins / Q000494:pharmacology; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000890:Anti-Infective Agents; D002511:Cephalosporins; D005839:Gentamicins; D013845:Thienamycins; D002939:Ciprofloxacin; D015378:Imipenem; D000077723:Cefepime; D001618:beta-Lactamases; D000077731:Meropenem