1887

Abstract

The aim was to study the clinical and microbiological features associated with a carbapenem-resistant isolate that had been selected by an ertapenem-containing regimen in a patient with mediastinitis despite high blood and mediastinal levels of ertapenem. Carbapenem resistance was characterized by conjugation, PCR, DNA sequencing and analysis of outer-membrane proteins. The isolates susceptible and resistant to the carbapenems were compared by ribotyping and PFGE. Resistance to all available -lactams was most probably due to combined production of extended-spectrum -lactamase (ESBL) CTX-M-15 and loss of OmpK36 porin. The results of ribotyping and PFGE suggest that the carbapenem-resistant strain was a derivative of the original mediastinal isolate rather than a superinfecting isolate. This observation stresses the risk of selection of pan-penem resistant strains of enterobacteria when ertapenem is used for the treatment of severe infections due to ESBL-producing enterobacteria.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.012468-0
2010-01-01
2021-03-06
Loading full text...

Full text loading...

/deliver/fulltext/jmm/59/1/115.html?itemId=/content/journal/jmm/10.1099/jmm.0.012468-0&mimeType=html&fmt=ahah

References

  1. Boyer H. W., Roulland-Dussoix D. A. 1969; Complementation analysis of the restriction and modification of DNA in Escherichia coli . J Mol Biol 41:459–472 [CrossRef]
    [Google Scholar]
  2. DiNubile M. J., Chow J. W., Satishchandran V., Polis A., Motyl M. R., Abramson M. A., Teppler H. 2005; Acquisition of resistant bowel flora during a double-blind randomized clinical trial of ertapenem versus piperacillin-tazobactam therapy for intraabdominal infections. Antimicrob Agents Chemother 49:3217–3221 [CrossRef]
    [Google Scholar]
  3. Doumith M., Ellington M. J., Livermore D. M., Woodford N. 2009; Molecular mechanisms disrupting porin expression in ertapenem-resistant Klebsiella and Enterobacter spp. clinical isolates from the UK. J Antimicrob Chemother 63:659–667 [CrossRef]
    [Google Scholar]
  4. Elliott E., Brink A. J., van Greune J., Els Z., Woodford N., Turton J., Warner M., Livermore D. M. 2006; In vivo development of ertapenem resistance in a patient with pneumonia caused by Klebsiella pneumoniae with an extended-spectrum beta-lactamase. Clin Infect Dis 42:e95–e98 [CrossRef]
    [Google Scholar]
  5. Hernandez-Alles S., Albert S., Alvarez D., Domenech-Sanchez A., Martinez-Martinez L., Gil J., Thomas J. M., Benedil V. J. 1999; Porin expression in clinical isolates of Klebsiella pneumoniae . Microbiology 145:673–679 [CrossRef]
    [Google Scholar]
  6. Landman D., Bratu S., Quale J. 2009; Contribution of OmpK36 to carbapenem susceptibility in KPC-producing Klebsiella pneumoniae . J Med Microbiol 58:1303–1308 [CrossRef]
    [Google Scholar]
  7. Leavitt A., Chmelnitsky I., Colodner R., Ofek I., Carmeli Y., Navon-Venezia S. 2009; Ertapenem resistance among extended-spectrum- β -lactamase-producing Klebsiella pneumoniae . J Clin Microbiol 47:969–974 [CrossRef]
    [Google Scholar]
  8. Livermore D. M., Sefton A. M., Scott G. M. 2003; Properties and potential of ertapenem. J Antimicrob Chemother 52:331–344 [CrossRef]
    [Google Scholar]
  9. Martínez-Martínez L., Pascual A., Hernández-Allés S., Alvarez-Díaz D., Suárez A. L., Tran J., Benedí V. J., Jacoby G. A. 1999; Roles of beta-lactamases and porins in activities of carbapenems and cephalosporins against Klebsiella pneumoniae . Antimicrob Agents Chemother 43:1669–1673
    [Google Scholar]
  10. Roy S., Higareda I., Angel-Muller E., Ismail M., Hague C., Adeyi B., Woods G. L., Teppler H. & Protocol 023 Study Group; 2003; Ertapenem once a day versus piperacillin-tazobactam every 6 hours for treatment of acute pelvic infections: a prospective, multicenter, randomized, double-blind study. Infect Dis Obstet Gynecol 11:27–37 [CrossRef]
    [Google Scholar]
  11. Schwaber M. J., Navon-Venezia S., Schwartz D., Carmeli Y. 2005; High levels of antimicrobial coresistance among extended-spectrum- β -lactamase producing Enterobacteriaceae . Antimicrob Agents Chemother 49:2137–2139 [CrossRef]
    [Google Scholar]
  12. Shah P. M., Isaacs R. D. 2003; Ertapenem, the first of a new group of carbapenems. J Antimicrob Chemother 52:538–542 [CrossRef]
    [Google Scholar]
  13. Solomkin J. S., Yellin A. E., Rotstein O. D., Christou N. V., Dellinger E. P., Tellado J. M., Malafaia O., Fernandez A., Choe K. A. other authors 2003; Ertapenem versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections: results of a double-blind, randomized comparative phase III trial. Ann Surg 237:235–245
    [Google Scholar]
  14. Tenover F. C., Arbeit R. D., Goering R. V., Mickelsen P. A., Murray B. E., Persing D. H., Swaminathan B. 1995; Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 33:2233–2239
    [Google Scholar]
  15. Wang X. D., Cai J. C., Zhou H. W., Zhang R., Chen G. X. 2009; Reduced susceptibility to carbapenems in Klebsiella pneumoniae clinical isolates associated with plasmid-mediated β -lactamase production and OmpK36 porin deficiency. J Med Microbiol 58:1196–1202 [CrossRef]
    [Google Scholar]
  16. Yellin A. E., Hassett J. M., Fernandez A., Geib J., Adeyi B., Woods G. L., Teppler H. & The 004 Intra-Abdominal Infection Study Group; 2002; Ertapenem monotherapy versus combination therapy with ceftriaxone plus metronidazole for treatment of complicated intra-abdominal infections in adults. Int J Antimicrob Agents 20:165–173 [CrossRef]
    [Google Scholar]
  17. Yellin A. E., Johnson J., Higareda I., Congeni B. L., Arrieta A. C., Fernsler D., West J., Gesser R. 2007; Ertapenem or ticarcillin/clavulanate for the treatment of intra-abdominal infections or acute pelvic infections in pediatric patients. Am J Surg 194:367–374 [CrossRef]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.012468-0
Loading
/content/journal/jmm/10.1099/jmm.0.012468-0
Loading

Data & Media loading...

Supplements

Supplementary material 1

PDF

Most cited this month Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error