title: Salvage therapy with tigecycline for recurrent infection caused by ertapenem-resistant extended-spectrum β-lactamase-producing Klebsiella pneumoniae.
abstract: Optimal antimicrobial therapy for infections due to ertapenem-resistant Enterobacteriaceae remains undetermined. In this study, a diabetic patient with recurrent pyomyositis and osteomyelitis caused by extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae developed ertapenem resistance after imipenem/cilastatin treatment, which was a currently recommended therapy. He was finally treated successfully using tigecycline. Ertapenem resistance was in part explained by the production of SHV-type ESBL and the absence of an outer membrane protein, OmpK36. Our observation suggests that tigecycline may be an alternative for invasive infections caused by ESBL-producing Enterobacteriaceae with decreased susceptibility to carbapenem.
authors.affiliation: Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan.
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Chen
authors.forename: Jing-Jou
authors.initials: JJ
authors.lastname: Yan
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Wu
authors.forename: Hsin-Chun
authors.initials: HC
authors.lastname: Lee
authors.forename: Chia-Ming
authors.initials: CM
authors.lastname: Chang
authors.forename: Nan-Yao
authors.initials: NY
authors.lastname: Lee
authors.forename: Nai-Ying
authors.initials: NY
authors.lastname: Ko
authors.forename: Li-Rong
authors.initials: LR
authors.lastname: Wang
authors.forename: Hsin-I
authors.initials: HI
authors.lastname: Shih
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Lee
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D048909:Diabetes Complications; D000077727:Ertapenem; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology; D052880:Pyomyositis / Q000188:drug therapy / Q000382:microbiology; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods*; D000078304:Tigecycline; D016896:Treatment Outcome; D047090:beta-Lactams / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D000078304:Tigecycline; D008911:Minocycline; D000077727:Ertapenem