JAC Advance Access originally published online on September 13, 2006
Journal of Antimicrobial Chemotherapy 2006 58(5):1074-1077; doi:10.1093/jac/dkl381
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Treatment of ESBL-producing Klebsiella pneumoniae bacteraemia with carbapenems or flomoxef: a retrospective study and laboratory analysis of the isolates
1Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine Taiwan 2 Infection Control Team, Chang Gung Memorial Hospital-Kaohsiung Medical Center 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan 3 Department of Clinical Pathology, Chang Gung Memorial Hospital-Lin-Kou Medical Center 5 Fu-Hsin Street, Kweishan, Taoyuan 333, Taiwan 4 Department of Medical Biotechnology and Laboratory Science, Chang Gung University College of Medicine 259 Wenhua 1st Road, Kweishan, Taoyuan 333, Taiwan
Received 29 May 2006; returned 10 June 2006; revised 22 August 2006; accepted 24 August 2006
*Corresponding author. Tel: +886-7-7317123 ext. 8304; Fax: +886-7-7322402; E-mail: 88b0{at}adm.cgmh.org.tw
Objectives: To better understand the clinical outcomes of patients with extended-spectrum ß-lactamase-producing Klebsiella pneumoniae (ESBL-KP) bacteraemia treated with either flomoxef or a carbapenem, and to evaluate the in vitro activities of these antibiotics against ESBL-KP.
Methods: Retrospective analyses to identify risk factors for mortality in patients with flomoxef-susceptible ESBL-KP, especially addressing the therapeutic roles of flomoxef and carbapenem. In vitro activities of flomoxef and carbapenem against flomoxef-susceptible ESBL-KP isolates were evaluated by susceptibility testing and time–kill study.
Results: Twenty-seven patients (flomoxef group, n = 7; carbapenem group, n = 20) were included. Clinical severity reflected by high Pitt bacteraemia score (
6) was an independent risk factor for mortality (OR 13.43; 95% CI, 1.08–166.73; P = 0.043), while use of flomoxef or a carbapenem was not. The MICs of flomoxef and carbapenem indicated that the tested ESBL-KP were susceptible to these antibiotics regardless of the inoculum size of 105 or 107 cfu/mL. Time–kill study showed that these antibiotics (flomoxef 8 mg/L and meropenem 4 mg/L) each acted actively against and inhibited the regrowth of the tested ESBL-KP for at least 24 h.
Conclusions: Flomoxef might be as clinically effective as a carbapenem in treating flomoxef-susceptible ESBL-KP bacteraemia.
Keywords: clinical outcome , in vitro activity , inoculum effect
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