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Failure of Cephalosporin Treatment for Bloodstream Infection Caused by Apparently Susceptible Klebsiella pneumoniae which Produced DHA-1?-Lactamase Induced by Clavulanic Acid
Cheol-In Kang, M.D.1, Hyunjoo Pai, M.D.4, Sung Han Kim, M.D.1, Hong-Bin Kim, M.D.1, Myoung-don Oh, M.D.1,3, Eui-Chong Kim, M.D.2,3, and Kang-Won Choe, M.D.1,3
Departments of Internal Medicine1 and Laboratory Medicine2, College of Medicine, Seoul National University, Seoul, Korea Clinical Research Institute3, Seoul National University Hospital, Seoul, Korea Department of Internal Medicine4, Hanyang University Co
Vol.36 Num.3 (p127~131)
Backgroud:The therapeutic option is limited for the infections caused by organisms producing plasmid- mediated AmpC beta-lactamases, increasingly identified worldwide. Two sporadic patients with bacteremia caused by K. pneumoniae possessing an unusual inducible ?-lactam resistant phenotype were found in a university hospital.
Materials & Methods:We conducted antibiotic susceptibility test according to NCCLS guideline. Also, we characterized ?-lactamase by isoelectric focusing.
Results:DHA-1 gene conferred the resistant phenotype. The patients had experienced treatment failure when treated with extended-spectrum cephalosporin. For the isolates the cephalosporin resistance was induced by clavulanic acid (and cefoxitin).
Conclusion:Theses results suggest that the extended-spectrum cephalosporins might not provide optimal therapeutic option for inducible DHA-1-producing K. pneumoniae infection, even when the pathogens are susceptible in vitro.
Keywords : Klebsiella, ?-lactamase, Cephalosporin resistance