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Journal of Clinical Microbiology, June 2001, p. 2206-2212, Vol. 39, No. 6
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.6.2206-2212.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Outcome of Cephalosporin Treatment for Serious Infections Due to Apparently Susceptible Organisms Producing Extended-Spectrum beta -Lactamases: Implications for the Clinical Microbiology Laboratory

David L. Paterson,1,2 Wen-Chien Ko,3 Anne Von Gottberg,4 Jose Maria Casellas,5 Lutfiye Mulazimoglu,6 Keith P. Klugman,4 Robert A. Bonomo,7 Louis B. Rice,7 Joseph G. McCormack,2 and Victor L. Yu1,*

Infectious Disease Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania1; Department of Medicine, University of Queensland, Brisbane, Australia2; Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan3; South African Institute of Medical Research, Johannesburg, South Africa4; Departmento de Infectologia y Microbiologia, Sanatorio San Lucas, Buenos Aires, Argentina5; Department of Microbiology, Marmara University, Istanbul, Turkey6; and Infectious Disease Section, VA Medical Center, Cleveland, Ohio7

Received 18 December 2000/Returned for modification 30 January 2001/Accepted 20 March 2001

Although extended-spectrum beta-lactamases (ESBLs) hydrolyze cephalosporin antibiotics, some ESBL-producing organisms are not resistant to all cephalosporins when tested in vitro. Some authors have suggested that screening klebsiellae or Escherichia coli for ESBL production is not clinically necessary, and when most recently surveyed the majority of American clinical microbiology laboratories did not make efforts to detect ESBLs. We performed a prospective, multinational study of Klebsiella pneumoniae bacteremia and identified 10 patients who were treated for ESBL-producing K. pneumoniae bacteremia with cephalosporins and whose infecting organisms were not resistant in vitro to the utilized cephalosporin. In addition, we reviewed 26 similar cases of severe infections which had previously been reported. Of these 36 patients, 4 had to be excluded from analysis. Of the remaining 32 patients, 100% (4 of 4) patients experienced clinical failure when MICs of the cephalosporin used for treatment were in the intermediate range and 54% (15 of 28) experienced failure when MICs of the cephalosporin used for treatment were in the susceptible range. Thus, it is clinically important to detect ESBL production by klebsiellae or E. coli even when cephalosporin MICs are in the susceptible range (<=  8 µg/ml) and to report ESBL-producing organisms as resistant to aztreonam and all cephalosporins (with the exception of cephamycins).

* Corresponding author. Mailing address: Infectious Disease Division, VA Medical Center, University Dr. C, Pittsburgh, PA 15240. Phone: (412) 688-6179. Fax: (412) 688-6950. E-mail: vly+{at}pitt.edu.

Journal of Clinical Microbiology, June 2001, p. 2206-2212, Vol. 39, No. 6
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.6.2206-2212.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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