title: [Aspects of the antimicrobial resistence profile in infections with Escherichia coli and Klebsiella pneumoniae in diabetic patients].
abstract: Infections in diabetic patient remains an important cause of morbidity and mortality, triggering and maintaining a prolonged metabolic imbalance. Emergence of extented spectrum beta-lactmase (ESBL) in Escherichia coli and Klebsiella pneumoniae is a major concern, because of the atypical manner infection acts in this group of imunodepressed patients and also for the limited therapeutic solutions. For this reason we have evaluated the profile of antimicrobial resistance of these pathogens in both diabetic and non diabetic patients.
  
  
  METHODS
  The aim of this study was to evaluate, in a retrospective case control study, the antibiotic susceptibility pattern in isolates of E. coli and Klebsiella spp. from different biological products in 49 diabetics and 150 non-diabetics admitted in The Clinical Hospital of Infectious Diseases Iaşi over a period of two years.
  
  
  RESULTS
  Most of strains of E. coli and Klebsiella spp. ESBL positive were found in uroculture. Significant differences in E. coli resistance rate between diabetics and nondiabetics were noted for amoxicillin-clavulanic acid and ciprofloxacin (31,4% vs.13,98%, p=0,04, respectively 52,9% vs. 24,46%, p=0,004). More isolates of ESBL positive K. pneumoniae were found in diabetic patients (50% vs. 24%). Ciprofloxacin resistance of K. pneumoniae was significantly higher in diabetics (75% vs 39%; p=0,05). There was no resistance in E. coli and K. pneumoniae isolates to imipenem in the diabetic group.
  
  
  CONCLUSIONS
  The high resistance rate to quinolones and 3rd generation cefalosporins limits their use for the treatment of Escherichia coli and K. pneumoniae infections. Other alternatives for empiric therapy in community and nosocomial-acquired infections in diabetic patient remains carbapenems, aminoglycosides and colimycin.
authors: Universităţii de Medicină şi Farmacie "Gr. T. Popa" Iaşi, Facultatea de Medicină.
authors: Cristina G
authors: CG
authors: Petrovici
authors: Carmen
authors: C
authors: Dorobăţ
authors: Mioara
authors: M
authors: Matei
authors: Andra
authors: A
authors: Teodor
authors: V
authors: V
authors: Luca
authors: Egidia
authors: E
authors: Miftode
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000627:therapeutic use; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D015780:Carbapenems / Q000627:therapeutic use; D016022:Case-Control Studies; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000627:therapeutic use; D019818:Clavulanic Acid / Q000627:therapeutic use; D003091:Colistin / Q000627:therapeutic use; D048909:Diabetes Complications / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D007223:Infant; D007710:Klebsiella Infections / Q000150:complications / Q000188:drug therapy*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015363:Quinolones / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D015780:Carbapenems; D002511:Cephalosporins; D015363:Quinolones; D019818:Clavulanic Acid; D002939:Ciprofloxacin; D015378:Imipenem; D000658:Amoxicillin; D003091:Colistin