TY - JOUR
T1 - Antibiotic options for treatment of pediatric infections with Enterobacteriaceae producing broad spectrum beta-lactamases
AU - Qin, Xuan
AU - Galanakis, Emmanouil
AU - Zerr, Danielle M.
AU - Weissman, Scott J.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2012
Y1 - 2012
N2 - Enterobacteriaceae are major pediatric pathogens, but little is known regarding treatment options for multidrug-resistant strains. In this study, we investigated the susceptibility patterns of healthcare- and community-associated Enterobacteriaceae isolates expressing plasmid-borne, broad-spectrum beta-lactam resistance (PBLR). Using E-test methodology, we tested susceptibility to imipenem, meropenem, ertapenem, doripenem, piperacillin-tazobactam, minocycline, tigecycline, fosfomycin, and colistin in all 90 clinical isolates (Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca and Salmonella enterica) which are derived from urine (n=62), blood (n=12), and other specimens (n=16). These strains are confirmed to carry PBLR determinants. Although malignancy, urogenital and neurological diseases, and multiple antibiotic exposure were present in most patients, twenty three isolates (26%) were characterized as communityassociated. Enterobacteriaceae isolates expressing PBLR retained in vitro susceptibility to colistin (100%), minocycline (72%), tigecycline (97%), and fosfomycin (92%). Five unlinked isolates (6%; two isolates of E. coli and three of K. pneumoniae) showed resistance to one or all carbapenem agents. All community-associated isolates were susceptible to carbapenems and exhibited greater susceptibility to other agents compared to healthcare-associated isolates. In our study population, carbapenems remained broadly active and colistin, fosfomycin, and tigecycline demonstrated therapeutic potential against PBLR-positive isolates. Our findings have implications for susceptibility testing and empirical antimicrobial strategies targeting serious pediatric infections.
AB - Enterobacteriaceae are major pediatric pathogens, but little is known regarding treatment options for multidrug-resistant strains. In this study, we investigated the susceptibility patterns of healthcare- and community-associated Enterobacteriaceae isolates expressing plasmid-borne, broad-spectrum beta-lactam resistance (PBLR). Using E-test methodology, we tested susceptibility to imipenem, meropenem, ertapenem, doripenem, piperacillin-tazobactam, minocycline, tigecycline, fosfomycin, and colistin in all 90 clinical isolates (Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca and Salmonella enterica) which are derived from urine (n=62), blood (n=12), and other specimens (n=16). These strains are confirmed to carry PBLR determinants. Although malignancy, urogenital and neurological diseases, and multiple antibiotic exposure were present in most patients, twenty three isolates (26%) were characterized as communityassociated. Enterobacteriaceae isolates expressing PBLR retained in vitro susceptibility to colistin (100%), minocycline (72%), tigecycline (97%), and fosfomycin (92%). Five unlinked isolates (6%; two isolates of E. coli and three of K. pneumoniae) showed resistance to one or all carbapenem agents. All community-associated isolates were susceptible to carbapenems and exhibited greater susceptibility to other agents compared to healthcare-associated isolates. In our study population, carbapenems remained broadly active and colistin, fosfomycin, and tigecycline demonstrated therapeutic potential against PBLR-positive isolates. Our findings have implications for susceptibility testing and empirical antimicrobial strategies targeting serious pediatric infections.
KW - Broad-spectrum beta-lactam resistance
KW - Enterobacteriaceae
KW - Plasmid-borne
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U2 - 10.2174/2211362611208020130
DO - 10.2174/2211362611208020130
M3 - Article
AN - SCOPUS:84892972408
SN - 2211-3525
VL - 10
SP - 130
EP - 135
JO - Anti-Infective Agents
JF - Anti-Infective Agents
IS - 2
ER -