Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0519030 (Klebsiella)
 21,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gram-negative bacilli (GNB) septicemia are among the most serious infections encountered in the hospital since they generally occur on debilitated patients and are due to the multi-drug resistant bacteria. A retrospective study relating to 195 septicemia was carried out with an aim studying epidemiologic profile, predisposing factors, entry sites for micro-organisms, responsible GNB and their antibiotic susceptibility. GNB septicemia were mainly frequent in intensive care units (34%) and surgery (31%). Previous antibiotherapy, invasive procedures and surgical acts were the principal predisposing factors. The entry sites for micro-organisms remained unknown in 1/3 of the cases. The most common source of septicemia was the urinary tract infections. E. coli was the most frequent isolated bacteria (26%) in the community acquired spticemia whereas Klebsiella-Enterobacter-Serratia (KES), Acinetobacter and Pseudomonas were mainly encountered in nosocomial infections. Imipenem remained the most active betalactamin on GNB (2% of resistance) with amikacin (16% of resistance) among aminoglycosides. The rate of mortality was 18%. Hospitalization wards (intensive care units, surgery), entry sites unknown, septic shock syndrome were the main factors of prognosis. The development of immunology and molecular biology should improve the outcome of these infections but the preventive measures remain the most effective.
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PMID:[Epidemiology of gram negative bacterial septicemias: data from a Tunisian hospital (1996-1998)]. 1253 26

The widespread use of beta-lactam antimicrobial agents as first-line therapy for the treatment of serious infections has led to the development of various resistances that have compromised the use of some agents. In certain countries, the lack of local or national surveillance programs limits the ability to detect these resistant strains and prevent their dissemination. A 10 medical center study in India was initiated to benchmark prevailing resistance rates for a range of bacterial pathogens to beta-lactams, and it found high rates of beta-lactamase-mediated resistance in Escherichia coli and Klebsiella spp. These rates included: cephalosporins (55.6-61.3% resistance), with extended-spectrum beta-lactamase (ESBL) phenotypes noted in over 60% of E. coli isolates and in Salmonella spp. (3.2-8.1%). Imipenem, a carbapenem, was the only antimicrobial agent tested with 100% activity against Enterobacteriaceae. Cefpirome was the most active of the tested cephalosporins, and all were fully active against methicillin-susceptible staphylococci with the exception of ceftazidime. Molecular and susceptibility characterization of 52 selected ESBL-producing strains showed a high level of co-resistance with aminoglycosides and fluoroquinolones, and clonal dissemination of resistant strains within medical centers. Collaborative studies, such as those presented here, can accurately detect changes in resistance patterns, and their continued use may help limit the further development and spread of bacterial resistances in India.
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PMID:Evaluation of the in vitro activity of six broad-spectrum beta-lactam antimicrobial agents tested against recent clinical isolates from India: a survey of ten medical center laboratories. 1254 43

Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Sfax-Tunisia (1993-1998). The choice of antimicrobial therapy for the treatment of bacteremia is often empirical and based on the knowledge of susceptibility profiles of the most common bacteria causing such infections. This study determines the bacterial etiology of bacteremic episodes and antimicrobial susceptibility patterns recorded at a teaching hospital, from January 1993 to December 1998. We collected 2979 strains responsible for bacteremia. Gram negative bacteria were predominant (60%). The organisms recovered most frequently were Staphylococcus aureus (18.9%), Escherichia coli (14.7%), Klebsiella pneumoniae (14%) and Pseudomonas aeruginosa (7.6%). The incidence of resistance to methicillin were 17.4% for Staphylococcus aureus and 26.8% for coagulase negative Staphylococcus. No resistance to glycopeptides was observed among the enterococci and staphylococci studied. 27.7% of enterobacteriaceae were resistant to third generation cephalosporins. Imipenem was the most active agent against gram negative bacteria. To carry out a surveillance of bacteremic episodes occurring at every hospital, it is necessary to provide valuable information which should be the basis for effective empiric therapy.
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PMID:[Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Sfax-Tunisia (1993-1998)]. 1500 Dec 36

Doripenem (S-4661), a new parenteral carbapenem, was tested against over 250 clinical isolates, mutants, and transconjugants of Enterobacteriaceae and Acinetobacter spp., selected or derived for their beta-lactamase expression characteristics. Imipenem, meropenem, and ertapenem were tested as comparators, along with cephalosporins and piperacillin-tazobactam, by using National Committee for Clinical Laboratory Standards agar dilution methodology. Doripenem MICs were from 0.03 to 0.25 microg/ml for Klebsiella isolates, irrespective of the presence of extended-spectrum beta-lactamases (ESBLs) or plasmid-mediated AmpC or hyperproduced K1 beta-lactamase. Similarly, MICs of doripenem for both AmpC-inducible and -derepressed Enterobacter isolates were 0.06 to 0.5 microg/ml. ESBL production did not raise the MICs of doripenem for Escherichia coli transconjugants, and studies with known expression mutants confirmed that neither inducible nor depressed AmpC beta-lactamase expression was protective in Enterobacter cloacae, Citrobacter freundii, Serratia marcescens, or Morganella morganii. In all of these respects, doripenem resembled meropenem and imipenem, whereas the MICs of ertapenem were raised (but still < or =1 microg/ml) for many ESBL-producing klebsiellas and AmpC-derepressed E. cloacae and C. freundii strains. Resistance to all carbapenems, including doripenem (MICs of mostly 16 to 64 microg/ml, compared with 0.25 to 1 microg/ml for typical strains), was seen in Acinetobacter isolates with metallo-beta-lactamases or OXA-carbapenemases. Isolates of Klebsiella and Serratia spp. with IMP, KPC, and SME beta-lactamases also were resistant to doripenem (MICs, 8 to >64 microg/ml) and to other carbapenems, although the continued apparent susceptibility (MICs, < or =0.5 microg/ml) of E. coli derivatives with cloned IMP-1 and NMC-A beta-lactamases suggested that carbapenem resistance might require other factors besides the enzymes.
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PMID:Comparative activities of doripenem versus isolates, mutants, and transconjugants of Enterobacteriaceae and Acinetobacter spp. with characterized beta-lactamases. 1504 35

Minimum inhibitory concentrations and time-kill curves were performed against 8 Klebsiella pneumoniae (4 non-extended-spectrum beta-lactamase[ESBL] and 4 ESBL) for piperacillin/tazobactam (40/5 microg/mL), cefepime (20 microg/mL), and meropenem (4 microg/mL) by using a standard and high inocula. Imipenem was evaluated only at the standard inoculum for the non-ESBL and ESBL isolates. Samples were withdrawn at 7 predetermined time-points over 24 hours and plated on trypticase soy agar plates. Minimum inhibitory concentrations were: piperacillin/tazobactam 4 to 8 microg/mL (ESBL and non-ESBL), cefepime 1 to 2 microg/mL (ESBL) and 0.06 to 0.125 microg/mL (non-ESBL), imipenem 0.125 to 0.25 microg/mL (ESBL and non-ESBL), and meropenem 0.03 to 0.06 microg/mL (ESBL and non-ESBL). Each antibiotic reached and maintained bactericidal killing (> or =3 log killing) for 24 hours against all non-ESBL isolates for both the standard and high inoculum. Cefepime, imipenem, and meropenem showed the same bactericidal activity against each ESBL isolate at the standard inoculum, whereas piperacillin/tazobactam showed bactericidal killing against only 1 ESBL isolate. At the high inoculum, cefepime and piperacillin/tazobactam were unable to maintain bactericidal activity against any of the ESBL isolates. Only meropenem was able to maintain bactericidal killing over 24 hours against the ESBL isolates at the high inoculum. In summary, meropenem and imipenem maintained bactericidal activity against non-ESBL and ESBL K. pneumoniae irrespective of the inoculum size. While piperacillin/tazobactam and cefepime are bactericidal against non-ESBL K. pneumoniae, their activity against ESBL K. pneumoniae is limited and based on the size of the inoculum. Until more data are available, piperacillin/tazobactam and cefepime should not be used for the treatment of ESBL K. pneumoniae.
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PMID:In vitro killing of parenteral beta-lactams against standard and high inocula of extended-spectrum beta-lactamase and non-ESBL producing Klebsiella pneumoniae. 1558 94

The occurrence and antimicrobial susceptibility of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae in patients attending Siriraj Hospital in Bangkok from August 2000 to January 2001 were determined. ESBL-producing isolates were screened with four different methods: disk diffusion according to the National Committee for Clinical Laboratory Standards (NCCLS) guidelines, Etest ESBL (CT/CTL and TZ/TZL), Oxoid combination discs and MIC Etest strip. Antimicrobial susceptibility testing were determined by a microdilution automatic method (VITEX system, bioMerieux). Of 22,178 clinical specimens, 400 (1.8%) K. pneumoniae were isolated Of 26% (104/400) of these isolates were suspected to be ESBL-producing. Rates of detection of ESBL-producing K. pneumoniae were 18.67%, 30% and 23.78% for blood, sputum and urine samples, respectively. Susceptibility testing has revealed that all 70 tested isolates including 53 isolates from blood and sputum and 17 isolates from urine samples were susceptible to imipenem (MIC< or =4 mg/L). None of the tested isolates were susceptible to cephalosporins, cephamycin and aztreonam. Rate of susceptibility to ciprofloxacin, levofloxacin, gentamicin and tobramycin were 60%, 64%, 28% and 9%, respectively, for isolates from blood and sputum; 71%, 71%, 18% and 6% for urinary isolates. The present findings revealed a high occurrence rate of multi-drug resistance ESBL-producing K. pneumoniae in patients attending the university hospital. Imipenem was highly active against ESBL-producing K. pneumoniae.
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PMID:Occurrence of extended-spectrum beta-lactamase in clinical isolates of Klebsiella pneumoniae in a University Hospital, Thailand. 1551 2

The objective is to investigate the trend of antimicrobial resistance among nosocomial gram-negative bacteria isolated from intensive care units in China. From 1996 to 2002, the minimum inhibitory concentrations (MICs) of 8 antibiotics for 10,585 isolates of gram-negative bacteria from 19 hospitals in 7 central cities were determined by Etest. From 1996 to 2002, a marked decrease in the susceptibility of Pseudomonas aeruginosa to imipenem was noticed along the years (81-62%). Percentage of multidrug resistance of strains in P. aeruginosa obviously increased (11.5% in 1996, 20.5% in 2002). Imipenem kept active against Escherichia coli (99.2-100% susceptible), Acinetobacter spp. (97.6-93.5%), Klebsiella spp. (94.9-100%), Enterobacter spp. (89-96%). Resistance to cephalosporins, ciprofloxacin, and cefoperazone/sulbactam was observed, particularly among E. coli to ciprofloxacin (42-25%) and cefotaxime (78-54%) and Enterobacter spp. to ceftazidime (51-44%) and cefotaxime (50-37%). Piperacillin/tazobactam kept stable and active against P. aeruginosa, E. coli, and Klebsiella spp. (80%), with an increasing trend, but not good, in Enterobacter spp. (63-58%). Extended-spectrum beta-lactamase-producing strains in E. coli (28.6-45.7%) and Klebsiella spp. (25.5-34.9%) increased during 2001-2002. There was no significant increase resistance in Enterobacteriaceae isolates and Acinetobacter spp. to imipenem, but it has obviously decreased activity in P. aeruginosa throughout the 7-year period in China. Resistance of tested gram-negative bacteria to most comparator antimicrobials increased at different levels from 1996 to 2002 in China.
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PMID:Surveillance for antimicrobial resistance among clinical isolates of gram-negative bacteria from intensive care unit patients in China, 1996 to 2002. 1576 7

Bowel colonization with resistant bacteria can develop in patients receiving broad-spectrum antimicrobial therapy. We compared the impact of two antimicrobial regimens often used to treat intraabdominal infections on susceptibility patterns of bowel flora at the end of therapy. In a double-blind clinical trial, adults with complicated intraabdominal infection requiring surgery were randomized to receive piperacillin-tazobactam (3.375 g every 6 h) or ertapenem (1 g once a day) for 4 to 14 days. Rectal swabs were obtained at baseline and at the end of study therapy to determine the acquisition rates of Enterobacteriaceae resistant to the study drug, extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli or Klebsiella species, Pseudomonas aeruginosa resistant to imipenem or piperacillin-tazobactam, and vancomycin-resistant Enterococcus faecalis or Enterococcus faecium. Treated patients were assessable for the acquisition of resistant bacteria if appropriate specimens were obtained at both time points. Enterobacteriaceae resistant to the treatment received were acquired during study therapy by 8/122 assessable piperacillin-tazobactam recipients (6.6%) compared to 0/122 assessable ertapenem recipients (P = 0.007). Neither ESBL-producing E. coli or Klebsiella species nor P. aeruginosa resistant to piperacillin-tazobactam was isolated from patients in either treatment group. Imipenem-resistant P. aeruginosa was acquired by two of the ertapenem recipients (1.6%) versus zero of the piperacillin-tazobactam recipients (P = 0.50). Vancomycin-resistant enterococci were acquired during therapy by 8/125 assessable ertapenem recipients (6.4%) versus 2/123 assessable piperacillin-tazobactam recipients (1.6%; P = 0.10). In this study, the acquisition of resistant Enterobacteriaceae occurred significantly more often in patients treated with piperacillin-tazobactam than in those treated with ertapenem.
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PMID:Acquisition of resistant bowel flora during a double-blind randomized clinical trial of ertapenem versus piperacillin-tazobactam therapy for intraabdominal infections. 1604 28

Previous studies have shown decreased in vitro activity of zwitterionic cephalosporins and carbapenems against porin-deficient Klebsiella pneumoniae expressing a plasmid-mediated AmpC-type beta-lactamase (PACBL). The in vitro and in vivo activities of cefepime and imipenem were evaluated against the porin-deficient strain K. pneumoniae C2 and its CMY-2-producing derivative [K. pneumoniae C2(pMG248)]. The MICs (in micrograms/milliliter) of cefepime and imipenem against K. pneumoniae C2 were 0.125 and 0.25, respectively, while the corresponding values against K. pneumoniae C2(pMG248) were 8 and 16. Cefepime showed a greater inoculum effect than imipenem against both strains. Imipenem showed a significant postantibiotic effect (>2 h) against K. pneumoniae C2(pMG248) at 1x, 2x, 4x, 6x, and 8x MIC. The maximum concentrations of drug in serum of cefepime and imipenem in a pneumonia model using mice were 124.1 and 16.9 mug/ml, respectively. DeltaT/MIC for K. pneumoniae C2 and C2(pMG248) were 1.29 h and 0.34 h for imipenem and 2.96 h and 1.27 h for cefepime. Both imipenem (30 mg/kg of body weight every 3 h) and cefepime (60 mg/kg every 4 h), administered for 72 h, increased the survival rate (86.6% and 100%) compared with untreated control animals (26.6%, P < 0.003) infected with K. pneumoniae C2. For the CMY-2-producing strain, imipenem, but not cefepime, increased the survival rate compared to the controls (86.6% and 40% versus 40%, P < 0.01). Bacterial concentration of the lungs was significantly decreased by both antimicrobials. In conclusion, imipenem was more active in terms of survival than cefepime for the treatment of murine pneumonia caused by a porin-deficient K. pneumoniae expressing PACBL CMY-2.
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PMID:Efficacy of cefepime and imipenem in experimental murine pneumonia caused by porin-deficient Klebsiella pneumoniae producing CMY-2 beta-Lactamase. 1604 41

We evaluated the antimicrobial spectrum and potency of cefepime and selected comparators agents against clinical bacterial strains collected in North America over a 6-year period (1998-2003). Isolates were consecutively collected from bloodstream (44%), respiratory tract (41%), urinary tract (6%), and skin/soft tissue (5%) infections in 48 medical centers. Isolates were susceptibility tested by reference broth microdilution methods in a central laboratory. Oxacillin-resistant staphylococci and enterococci were excluded from the analysis. Imipenem (MIC90 = 1 microg/mL, 99.9% susceptible) was the most active compound tested against Enterobacteriaceae (22860 isolates tested) followed by cefepime (MIC90 = 0.25 microg/mL, 99.5% susceptible) > amikacin (99.4% susceptible) > ceftriaxone (95.6% susceptible) > aztreonam (95.1% susceptible). Among comparators, the lowest susceptibility rate for Enterobacteriaceae was observed with ciprofloxacin (92.8% susceptible). Imipenem was also the most active compound against ESBL-producing Klebsiella spp. and Escherichia coli (99.3% and 100% susceptible, respectively), followed by amikacin (81.4% and 97.2% susceptible, respectively) and cefepime (92.5% and 93.8% susceptible, respectively). Cefepime activity against Pseudomonas aeruginosa (85.2% susceptible) was similar to that of imipenem (86.9% susceptible). Against oxacillin-susceptible Staphylococcus aureus, cefepime (MIC90 = 4 microg/mL, 100.0% susceptible) was 4-fold more active than ceftazidime (MIC90 = 16 microg/mL, 86.4% susceptible) and showed a higher susceptibility rate than ciprofloxacin (93.2% susceptible). Cefepime was the most active compound tested against Streptococcus pneumoniae (MIC90 = 1 microg/mL, 97.4% susceptible), ranked after gatifloxacin and levofloxacin (99.2% susceptible). The activity of cefepime remained stable during the study period evaluated with the susceptibility rates varying from 99.3% to 99.8% among the Enterobacteriaceae and 84.4% to 88.4% among P. aeruginosa isolates. In summary, cefepime has retained broad activity and spectrum against Enterobacteriaceae, P. aeruginosa, and Gram-positive cocci (except oxacillin-resistant staphylococci and enterococci) isolated from North American medical centers in the 1998-2003 period. Continued resistance surveillance is critical to monitor the effectiveness of widely used parenteral antimicrobial agents such as cefepime.
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PMID:Potency and spectrum trends for cefepime tested against 65746 clinical bacterial isolates collected in North American medical centers: results from the SENTRY Antimicrobial Surveillance Program (1998-2003). 1610 69


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