Clinical and microbiologic analysis of a hospital's extended-spectrum β-lactamase-producing isolates over a 2-year period

David S. Burgess, Ronald G. Hall, James S. Lewis, James H. Jorgensen, Jan E. Patterson

Research output: Contribution to journalArticle

63 Scopus citations

Abstract

Study Objective. To evaluate the microbiologic and clinical outcomes of patients with extended-spectrum β-lactamase (ESBL)-producing isolates over a 2-year period. Design. Retrospective analysis. Setting. Tertiary care teaching hospital. Patients. Twenty-one patients with cultures of confirmed ESBL-producing Escherichia coli, Klebsiella pneumoniae, or Klebsiella oxytoca. Measurements and Main Results. Antimicrobial susceptibilities of piperacillin-tazobactam, cefotetan, carbapenems, aminoglycosides, fluoroquinolones, trimethoprim-sulfamethoxazole, and nitrofurantoin (nitrofurantoin for urinary isolates only) of confirmed ESBL producers at our institution were determined, as well as clinical outcomes of patients with ESBL-producing isolates. Microbiologic and medical records were reviewed for patient sex and age, antimicrobial susceptibilities, antimicrobial therapy, and clinical and microbiologic outcomes. From January 2000-December 2001, 31 isolates were confirmed as ESBL producers (6 E. coli, 11 K. pneumoniae, and 14 K. oxytoca). A statistically significant increase occurred over the 2-year period from 9 (0.6%) of 1414 isolates in 2000 to 22 (1.8%) of 1218 isolates in 2001 (p=0.0055). All isolates were susceptible to carbapenems, and more than 88% were susceptible to amikacin, cefotetan, or nitrofurantoin. Less than 70% of isolates were susceptible to gentamicin, fluoroquinolones, piperacillin-tazobactam, or trimethoprim-sulfamethoxazole. All patients treated with a carbapenem experienced clinical cure. Piperacillin-tazobactam alone and in combination resulted in an overall clinical cure rate of 55%, with a 50% cure rate for isolates susceptible to piperacillin-tazobactam. All patients in whom antibiotic therapy failed had been treated with piperacillin-tazobactam or cefepime, either alone or in combination with a fluoroquinolone. Conclusion. Carbapenems remain the treatment of choice for ESBL-producing pathogens. Piperacillin-tazobactam and cefepime should not be routinely administered for the treatment of these organisms.

Original languageEnglish (US)
Pages (from-to)1232-1237
Number of pages6
JournalPharmacotherapy
Volume23
Issue number10 II
DOIs
StatePublished - Oct 1 2003

ASJC Scopus subject areas

  • Pharmacology (medical)

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