TY - JOUR
T1 - Epidemiology of ciprofloxacin resistance and its relationship, to extended-spectrum β-lactamase production in Klebsiella pneumoniae isolates causing bacteremia
AU - Paterson, David L.
AU - Mulazimoglu, Lutfiye
AU - Casellas, Jose Maria
AU - Ko, Wen Chien
AU - Goossens, Herman
AU - Von Gottberg, Anne
AU - Mohapatra, Sunita
AU - Trenholme, Gordon M.
AU - Klugman, Keith P.
AU - McCormack, Joseph G.
AU - Yu, Victor L.
PY - 2000
Y1 - 2000
N2 - A prospective study of Klebsiella pneumoniae bacteremia was performed in 12 hospitals in 7 countries. Of 452 episodes of bacteremia, 25 (5.5%) were caused by K. pneumoniae that was resistant in vitro to ciprofloxacin. Extended-spectrum β-lactamase (ESBL) production was detected in 15 (60%) of 25 ciprofloxacin-resistant isolates, compared with 68 (16%) of 427 ciprofloxacin-susceptible strains (P = .0001). Multivariate analysis revealed that risk factors for ciprofloxacin resistance in K. pneumoniae included prior receipt of a quinolone (P = .0065) and an ESBL-producing strain (P = .012). In all, 18% of ESBL-producing isolates were also ciprofloxacin- resistant. Pulsed-field gel electrophoresis showed that 11 of the 15 ciprofloxacin-resistant ESBL-producing strains belonged to just 4 genotypes, suggesting that patient-to-patient transmission of such strains occurred. The close relationship between ESBL production and ciprofloxacin resistance is particularly worrisome because the first reported instance of plasmid- mediated ciprofloxacin resistance has been in an isolate of K. pneumoniae also possessing an ESBL.
AB - A prospective study of Klebsiella pneumoniae bacteremia was performed in 12 hospitals in 7 countries. Of 452 episodes of bacteremia, 25 (5.5%) were caused by K. pneumoniae that was resistant in vitro to ciprofloxacin. Extended-spectrum β-lactamase (ESBL) production was detected in 15 (60%) of 25 ciprofloxacin-resistant isolates, compared with 68 (16%) of 427 ciprofloxacin-susceptible strains (P = .0001). Multivariate analysis revealed that risk factors for ciprofloxacin resistance in K. pneumoniae included prior receipt of a quinolone (P = .0065) and an ESBL-producing strain (P = .012). In all, 18% of ESBL-producing isolates were also ciprofloxacin- resistant. Pulsed-field gel electrophoresis showed that 11 of the 15 ciprofloxacin-resistant ESBL-producing strains belonged to just 4 genotypes, suggesting that patient-to-patient transmission of such strains occurred. The close relationship between ESBL production and ciprofloxacin resistance is particularly worrisome because the first reported instance of plasmid- mediated ciprofloxacin resistance has been in an isolate of K. pneumoniae also possessing an ESBL.
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U2 - 10.1086/313719
DO - 10.1086/313719
M3 - Article
C2 - 10722430
AN - SCOPUS:0034034589
SN - 1058-4838
VL - 30
SP - 473
EP - 478
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 3
ER -