Epidemiology of Ciprofloxacin Resistance and Its Relationship to Extended-Spectrum [beta]-Lactamase Production in Klebsiella pneumoniae Isolates Causing Bacteremia.
Paterson, David L. 1,3; Mulazimoglu, Lutfiye 4; Casellas, Jose Maria 5; Ko, Wen-Chien 6; Goossens, Herman 7; Von Gottberg, Anne 8; Mohapatra, Sunita 2; Trenholme, Gordon M. 2; Klugman, Keith P. 8; McCormack, Joseph G. 3; Yu, Victor L. 1
[Article] Clinical Infectious Diseases. 30(3):473-478, March 2000.

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: A prospective study of Klebsiella pneumoniae bacteremia was performed in 12 hospitals in 7 countries. Of 452 episodes of bacteremia, 25 (5.5%) were caused by K. pneumoniae that was resistant in vitro to ciprofloxacin. Extended-spectrum [beta]-lactamase (ESBL) production was detected in 15 (60%) of 25 ciprofloxacin-resistant isolates, compared with 68 (16%) of 427 ciprofloxacin-susceptible strains (P = .0001). Multivariate analysis revealed that risk factors for ciprofloxacin resistance in K. pneumoniae included prior receipt of a quinolone (P = .0065) and an ESBL-producing strain (P = .012). In all, 18% of ESBL-producing isolates were also ciprofloxacin-resistant. Pulsed-field gel electrophoresis showed that 11 of the 15 ciprofloxacin-resistant ESBL-producing strains belonged to just 4 genotypes, suggesting that patient-to-patient transmission of such strains occurred. The close relationship between ESBL production and ciprofloxacin resistance is particularly worrisome because the first reported instance of plasmid-mediated ciprofloxacin resistance has been in an isolate of K. pneumoniae also possessing an ESBL.

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