Refractory vertebral osteomyelitis due to CTX-M-14-producing Escherichia coli at ertapenem treatment in a patient with a coexisting urinary tract infection caused by the same pathogen.
We report the case of a patient with vertebral osteomyelitis and concurrent urinary tract infection (UTI) in which extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (EC(1)) isolated from urine culture was ciprofloxacin-resistant and ertapenem/imipenem-susceptible. The empirically used oral form of ciprofloxacin was switched to parenteral ertapenem based on the antimicrobial susceptibility. However, vertebral osteomyelitis deteriorated, and despite the disappearance of pyuria and a negative urine culture, ESBL-producing E. coli was isolated from a biopsy of the bony material from the fifth lumbar vertebra (EC(2)) and blood culture (EC(3)) at 10 and 12 days after starting ertapenem, respectively. Ertapenem was switched to imipenem, and defervescence occurred 2 days later; a subsequent blood culture was negative. Genotyping indicated that EC(1), EC(2), and EC(3) were of the same clone, with the ESBL being CTX-M-14. The tested antibiotics had identical minimum inhibitory concentrations against each of these isolates. From the pharmacokinetics/pharmacodynamics points of view, it is reasonable to attribute the ertapenem treatment failure in vertebral osteomyelitis due to ESBL-producing E. coli in this case to the suboptimal ertapenem concentration in the inflammatory bone tissue of the host.
Lee
Chen Hsiang
CH
Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan.
Su
Lin-Hui
LH
Lin
Wei-Che
WC
Tang
Yang-Fang
YF
Liu
Jien-Wei
JW
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D000077727:Ertapenem; D004926:Escherichia coli / Q000187:drug effects* / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology*; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology*; D013122:Spinal Diseases / Q000188:drug therapy* / Q000382:microbiology*; D017211:Treatment Failure; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis*; D047090:beta-Lactams / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D015378:Imipenem; C456080:beta-lactamase CTX-M-14; D001618:beta-Lactamases; D000077727:Ertapenem