Development of ertapenem resistance in a patient with mediastinitis caused by Klebsiella pneumoniae producing an extended-spectrum beta-lactamase.
The aim was to study the clinical and microbiological features associated with a carbapenem-resistant Klebsiella pneumoniae isolate that had been selected in vivo by an ertapenem-containing regimen in a patient with mediastinitis despite high blood and mediastinal levels of ertapenem. Carbapenem resistance was characterized by conjugation, PCR, DNA sequencing and analysis of outer-membrane proteins. The isolates susceptible and resistant to the carbapenems were compared by ribotyping and PFGE. Resistance to all available beta-lactams was most probably due to combined production of extended-spectrum beta-lactamase (ESBL) CTX-M-15 and loss of OmpK36 porin. The results of ribotyping and PFGE suggest that the carbapenem-resistant strain was a derivative of the original mediastinal isolate rather than a superinfecting isolate. This observation stresses the risk of selection of pan-penem resistant strains of enterobacteria when ertapenem is used for the treatment of severe infections due to ESBL-producing enterobacteria.
Skurnik
David
D
Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard APHP, Université Paris VII, 46 rue Henri Huchard, 75877 Paris Cedex 18, France.
Lasocki
Sigismond
S
Réanimation chirurgicale, Hôpital Bichat-Claude Bernard APHP, Université Paris VII, 46 rue Henri Huchard, 75877 Paris Cedex 18, France.
Bremont
Sylvie
S
Unité des Agents Antibactériens, Institut Pasteur, Paris, France.
Muller-Serieys
Claudette
C
Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard APHP, Université Paris VII, 46 rue Henri Huchard, 75877 Paris Cedex 18, France.
Kitzis
Marie Dominique
MD
Fondation Hôpital Saint Joseph, Paris, France.
Courvalin
Patrice
P
Unité des Agents Antibactériens, Institut Pasteur, Paris, France.
Andremont
Antoine
A
Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard APHP, Université Paris VII, 46 rue Henri Huchard, 75877 Paris Cedex 18, France.
Montravers
Philippe
P
Réanimation chirurgicale, Hôpital Bichat-Claude Bernard APHP, Université Paris VII, 46 rue Henri Huchard, 75877 Paris Cedex 18, France.
D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D008297:Male; D008480:Mediastinitis / Q000188:drug therapy / Q000382:microbiology*; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology; D013997:Time Factors; D001618:beta-Lactamases / Q000378:metabolism*
D000900:Anti-Bacterial Agents; D001618:beta-Lactamases