Skurnik D, Lasocki S, Bremont S, Muller-Serieys C, Kitzis D, Courvalin P, Andremont A, Montravers P
Development of ertapenem resistance in a patient with mediastinitis caused by an extended-spectrum beta-lactamase producing Klebsiella pneumoniae. [JOURNAL ARTICLE]
J Med Microbiol 2009 Sep 10.
To study the clinical and microbiological features associated with a carbapenem-resistant K. pneumoniae isolate that has been selected in vivo 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 beta-lactams was most probably due to combined production of extended spectrum beta-lactamase 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.
More from this journal |
