The online version of this article (doi:10.1186/1471-2334-14-1) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
YTL conceived the study, and participated in its design and coordination. YTL, FDW, YJC, and YCF reviewed and collected the data. YTL analyzed and interpreted the data. YTL drafted the manuscript. FDW and CPF reviewed the manuscript. All authors approved the final manuscript.
Resistance among Klebsiella pneumoniae to most antibiotics is on the rise. Tigecycline has been considered as one of the few therapeutic options available to treat multidrug-resistant bacteria. We investigated the clinical and microbiological characteristics of tigecycline non-susceptible K. pneumoniae bacteremia.
Adult patients with tigecycline non-susceptible K. pneumoniae bacteremia at a medical center in Taiwan over a 3-year period were enrolled. K. pneumoniae isolates were identified by the E-test using criteria set by the US Food and Drug Administration (FDA). Data on the clinical features of patients were collected from medical records. Genes for β-lactamases, antimicrobial susceptibilities and pulsed-field gel electrophoresis (PFGE) results were determined for all isolates.
Of 36 patients, 27 had nosocomial bacteremia. Overall 28-day mortality was 38.9%. The MIC50 and MIC90 of tigecycline were 6 and 8 mg/L, respectively. No carbapenemase was detected among the 36 isolates. Twenty isolates carried extended spectrum β-lactamases and/or DHA-1 genes. No major cluster of isolates was found among the 36 isolates by PFGE. Intensive care unit onset of tigecycline non-susceptible Klebsiella pneumoniae bacteremia was the only independent risk factor for 28-day mortality.
The high mortality of patients with tigecycline non-susceptible K. pneumoniae bacteremia may suggest a critical problem. Further study to identify the possible risk factors for its development and further investigation of this type of bacteremia is necessary.
Livermore DM: Has the era of untreatable infections arrived?. J Antimicrob Chemother. 2009, i29-36. 1
Rodríguez-Avial C, Rodríguez-Avial I, Merino P, Picazo JJ: Klebsiella pneumoniae: development of a mixed population of carbapenem and tigecycline resistance during antimicrobial therapy in a kidney transplant patient. Clin Microbiol Infect. 2012, 18: 61-6. 10.1111/j.1469-0691.2011.03482.x. CrossRefPubMed
Tsai HY, Liao CH, Cheng A, Liu CY, Huang YT, Sheng WH, Hsueh PR: Emergence of tigecycline-resistant Klebsiella pneumoniae after tigecycline therapy for complicated urinary tract infection caused by carbapenem-resistant Escherichia coli. J Infect. 2012, 65: 584-6. 10.1016/j.jinf.2012.09.007. CrossRefPubMed
Roy S, Datta S, Viswanathan R, Singh AK, Basu S: Tigecycline susceptibility in Klebsiella pneumoniae and Escherichia coli causing neonatal septicaemia (2007–10) and role of an efflux pump in tigecycline non-susceptibility. J Antimicrob Chemother. 2013, 68: 1036-42. 10.1093/jac/dks535. CrossRefPubMed
Clinical and Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing: twenty-second informational supplement. 2012, Wayne, PA: CLSI: Document M100-S22
Qureshi ZA, Paterson DL, Peleg AY, Adams-Haduch JM, Shutt KA, Pakstis DL, Sordillo E, Polsky B, Sandkovsky G, Bhussar MK, Doi Y: Clinical characteristics of bacteraemia caused by extended-spectrum β-lactamase-producing Enterobacteriaceae in the era of CTX-M-type and KPC-type β-lactamases. Clin Microbiol Infect. 2012, 18: 887-93. 10.1111/j.1469-0691.2011.03658.x. CrossRefPubMed
Zarkotou O, Pournaras S, Altouvas G, Pitiriga V, Tziraki M, Mamali V, Themeli-Digalaki K, Tsakris A: Comparative evaluation of tigecycline susceptibility testing methods for expanded-spectrum cephalosporin- and carbapenem-resistant Gram-negative pathogens. J Clin Microbiol. 2012, 50: 3747-50. 10.1128/JCM.02037-12. CrossRefPubMedPubMedCentral
Qureshi ZA, Paterson DL, Potoski BA, Kilayko MC, Sandovsky G, Sordillo E, Polsky B, Adams-Haduch JM, Doi Y: Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: superiority of combination antimicrobial regimens. Antimicrob Agents Chemother. 2012, 56: 2108-13. 10.1128/AAC.06268-11. CrossRefPubMedPubMedCentral
Tumbarello M, Viale P, Viscoli C, Trecarichi EM, Tumietto F, Marchese A, Spanu T, Ambretti S, Ginocchio F, Cristini F, Losito AR, Tedeschi S, Cauda R, Bassetti M: Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase–producing K. pneumoniae: importance of combination therapy. Clin Infect Dis. 2012, 55: 943-50. 10.1093/cid/cis588. CrossRefPubMed
Capone A, Giannella M, Fortini D, Giordano A, Meledandri M, Ballardini M, Venditti M, Bordi E, Capozzi D, Balice MP, Tarasi A, Parisi G, Lappa A, Carattoli A, Petrosillo N , SEERBIO-GRAB network: High rate of colistin resistance among patients with carbapenem-resistant Klebsiella pneumoniae infection accounts for an excess of mortality. Clin Microbiol Infect. 2013, 19: E23-E30. 10.1111/1469-0691.12070. CrossRefPubMed
Nigo M, Cevallos CS, Woods K, Flores VM, Francis G, Perlman DC, Revuelta M, Mildvan D, Waldron M, Gomez T, Koshy S, Jodlowski T, Riley W, Ruhe JJ: Nested case–control study of the emergence of tigecycline resistance in multidrug-resistant Klebsiella pneumoniae. Antimicrob Agents Chemother. 2013, 57: 5743-6. 10.1128/AAC.00827-13. CrossRefPubMedPubMedCentral
- Clinical and microbiological characteristics of tigecycline non-susceptible Klebsiella pneumoniaebacteremia in Taiwan
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II