Epidemiology of Ciprofloxacin Resistance and Its Relationship to Extended-Spectrum -Lactamase Production in Klebsiella pneumoniae Isolates Causing Bacteremia
Open Access
- 1 March 2000
- journal article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 30 (3), 473-478
- https://doi.org/10.1086/313719
Abstract
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.This publication has 16 references indexed in Scilit:
- The global epidemiology of resistance to ciprofloxacin and the changing nature of antibiotic resistance: a 10 year perspectiveJournal of Antimicrobial Chemotherapy, 1999
- In-vitro susceptibility of 1982 respiratory tract pathogens and 1921 urinary tract pathogens against 19 antimicrobial agents: a Canadian multicentre studyJournal of Antimicrobial Chemotherapy, 1999
- Combination antibiotic therapy versus monotherapy for gram-negative bacteraemia: a commentaryInternational Journal of Antimicrobial Agents, 1999
- Antimicrobial susceptibilities of blood culture isolates obtained before and after the introduction of ciprofloxacinJournal of Antimicrobial Chemotherapy, 1997
- Critical appraisal of E test for the detection of fluoroquinolone resistanceJournal of Antimicrobial Chemotherapy, 1996
- Multicenter Spanish study of ciprofloxacin susceptibility in gram-negative bacteriaEuropean Journal of Clinical Microbiology & Infectious Diseases, 1995
- Relationship between quinolone use and emergence of ciprofloxacin-resistant Escherichia coli in bloodstream infectionsAntimicrobial Agents and Chemotherapy, 1995
- Epidemiology of Quinolone ResistanceDrugs, 1995
- Extended-spectrum beta-lactamasesAntimicrobial Agents and Chemotherapy, 1989
- CDC definitions for nosocomial infections, 1988American Journal of Infection Control, 1988