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JAC Advance Access published online on September 13, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl381
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Received May 29, 2006
Revised August 22, 2006
Accepted August 24, 2006

Brief report

Treatment of ESBL-producing Klebsiella pneumoniae bacteraemia with carbapenems or flomoxef: a retrospective study and laboratory analysis of the isolates

Chen-Hsiang Lee 1, Lin-Hui Su 2, Ya-Fen Tang 3, and Jien-Wei Liu 1 *

1 Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan; Infection Control Team, Chang Gung Memorial Hospital-Kaohsiung Medical Center, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan
2 Department of Clinical Pathology, Chang Gung Memorial Hospital-Lin-Kou Medical Center, 5 Fu-Hsin Street, Kweishan, Taoyuan 333, Taiwan; Department of Medical Biotechnology and Laboratory Science, Chang Gung University College of Medicine, 259 Wenhua 1st Road, Kweishan, Taoyuan 333, Taiwan
3 Infection Control Team, Chang Gung Memorial Hospital-Kaohsiung Medical Center, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan

* To whom correspondence should be addressed.
Jien-Wei Liu, E-mail: 88b0{at}adm.cgmh.org.tw


  Abstract

Objectives: To better understand the clinical outcomes of patients with extended-spectrum {beta}-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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