TY - JOUR
T1 - A pragmatic approach to identify extended-spectrum β-lactamase- producing klebsiella pneumoniae in taiwan
T2 - In vitro activity of newer and established antimicrobial agents
AU - Yu, Wen-Liang
AU - Chuang, Yin Ching
AU - Jones, Ronald N.
PY - 2004/4
Y1 - 2004/4
N2 - The activities of 17 antimicrobials were evaluated against 211 clinical extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae isolates from Taiwan. A pragmatic approach by sequential Etest (AB BIODISK, Solna, Sweden) ESBL screen (narrow MIC range) and/or the usual Etest method (broad MIC range) was used. Among 131 isolates with a ceftazidime MIC of > 8 μg/ml, 125 (95.4%) had a reduction of ≥3 log 2 dilution steps for ceftazidime (positive test). Among 83 isolates with a ceftriaxone MIC of > 8 μg/ml and ceftazidime MIC at ≤8 μg/ml, 81 (97.5%) had a reduction of ≥3 three log 2 dilution steps for ceftriaxone. Among the remaining eight isolates with nondeterminable results, additional Etest MIC method results revealed five ESBL-positive and two ESBL-negative (putative AmpC) determinations. This approach offered a cost-effective strategy to screen for ESBL among large number of isolates. The carbapenems (meropenem and imipenem) were the most active compounds (100% susceptibility) followed by newer fluoroquinolones (levofloxacin, gemifloxacin and gatifloxacin) at approximately 80% susceptible. Co-resistance to gentamicin was 96%, tobramycin 96%, and amikacin 62%. In conclusion, ESBL-producing strains of K. pneumoniae, also resistant to cefepime and aminoglycosides, are now widespread in Taiwan. The carbapenems and newer fluoroquinolones remain quite active against these ESBL strains recognized by this novel diagnostic approach.
AB - The activities of 17 antimicrobials were evaluated against 211 clinical extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae isolates from Taiwan. A pragmatic approach by sequential Etest (AB BIODISK, Solna, Sweden) ESBL screen (narrow MIC range) and/or the usual Etest method (broad MIC range) was used. Among 131 isolates with a ceftazidime MIC of > 8 μg/ml, 125 (95.4%) had a reduction of ≥3 log 2 dilution steps for ceftazidime (positive test). Among 83 isolates with a ceftriaxone MIC of > 8 μg/ml and ceftazidime MIC at ≤8 μg/ml, 81 (97.5%) had a reduction of ≥3 three log 2 dilution steps for ceftriaxone. Among the remaining eight isolates with nondeterminable results, additional Etest MIC method results revealed five ESBL-positive and two ESBL-negative (putative AmpC) determinations. This approach offered a cost-effective strategy to screen for ESBL among large number of isolates. The carbapenems (meropenem and imipenem) were the most active compounds (100% susceptibility) followed by newer fluoroquinolones (levofloxacin, gemifloxacin and gatifloxacin) at approximately 80% susceptible. Co-resistance to gentamicin was 96%, tobramycin 96%, and amikacin 62%. In conclusion, ESBL-producing strains of K. pneumoniae, also resistant to cefepime and aminoglycosides, are now widespread in Taiwan. The carbapenems and newer fluoroquinolones remain quite active against these ESBL strains recognized by this novel diagnostic approach.
KW - ESBL
KW - Etest
KW - Extended-spectrum β-lactamase
KW - Klebsiella pneumoniae
KW - Screening
KW - Taiwan
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U2 - 10.1016/j.diagmicrobio.2003.11.001
DO - 10.1016/j.diagmicrobio.2003.11.001
M3 - Article
C2 - 15062921
AN - SCOPUS:1942535145
SN - 0732-8893
VL - 48
SP - 277
EP - 282
JO - Diagnostic Microbiology and Infectious Disease
JF - Diagnostic Microbiology and Infectious Disease
IS - 4
ER -
