Clinical and Microbiologic Analysis of a Hospital’s.

 Report Lens system: To evaluate the microbiologic and clinical outcomes of patients with extended-spectrum ß-lactamase (ESBL)-producing isolates over a 2-year time period. Organisation: Retrospective depth psychology. Place setting: Tertiary care commandment medical institution. 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, bactrim, and nitrofurantoin (nitrofurantoin for urinary isolates only) of confirmed ESBL producers at our tradition were determined, as well as clinical outcomes of patients with ESBL-producing isolates.
Microbiologic and medical records were reviewed for semantic role 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 growth occurred over the 2-year catamenia 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 coalition resulted in an work-clothing 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 alliance with a fluoroquinolone. Occurrent: Carbapenems remain the direction of deciding for ESBL-producing pathogens.
Piperacillin-tazobactam and cefepime should not be routinely administered for the intervention of these organisms.Text edition
Extended-spectrum ß-lactamase (ESBL)-producing organisms are an increasing job for practitioners group action with infectious diseases. Escherichia coli, Klebsiella pneumoniae, and Klebsiella oxytoca are the most common ESBL-producing pathogens.
Several recent reviews have discussed ESBL-producing organisms in discussion. However, a few important points should be remembered when comparing ESBL-producing organisms with other ß-lactamase- producing organisms.
Traditional TEM and SHV ß-lactamases can be inhibited by ß-lactam-ß-lactamase inhibitor combinations and extended-spectrum cephalosporins (e.g., ceftazidime, cefotaxime, and ceftriaxone).
However, ESBL enzymes can hydrolyze the extended-spectrum cephalosporins, and some ESBL enzymes can hydrolyze ß-lactamase inhibitors.
Furthermore, studies have demonstrated that ESBL-producing pathogens can communication an inoculum feeling against ß-lactam-ß-lactamase inhibitors as well as cefepime.
The ESBL-producing organisms differ significantly from AmpC ß-lactamase-producing organisms in that ESBL producers are generally susceptible to cephamycins (e.g., cefoxitin and cefotetan) in vitro.
Also, ESBLs are encoded by genes on plasmids.
The locating of these genes on plasmids results in easier mortal of ESBL enzymes to other bacterial taxonomic category compared with AmpC ß-lactamase enzymes, which are located on the chromosomes of Enterobacter sp, Citrobacter freundii, Morganella morganii, Serratia marcescens, and Pseudomonas aeruginosa. However, reports of plasmid-mediated AmpC enzymes will further the difficulties of pheno-typically identifying ß-lactamases.
The National Commission for Clinical Workplace Standards (NCCLS) recommends that microbiology laboratories write up ESBL-producing isolates of E. coli and Klebsiella sp as resistant to all penicillins, cephalosporins (including cefepime), and aztreonam irrespective of their soul in vitro test results. In stark orbit to the cephalosporins, the NCCLS does not recommend reporting ESBL-producing organisms resistant to ß-lactam-ß-lactamase inhibitor combinations unless the isolates exceed currently defined susceptibility breakpoints for those organisms.
Clinical data determining the efficacy of these agents in ESBL-associated infections are sparse.
Carbapenems are considered the therapy of deciding for patients with ESBL-producing organisms.
We observed the microbiologic and clinical features of such patients at our tradition.
This is a part of article Clinical and Microbiologic Analysis of a Hospital’s. Taken from "Bactrim Information" Information Blog