Epidemiology of Ciprofloxacin Resistance and Its Relationship to Extended-Spectrum Beta-Lactamase Production in Klebsiella Pneumoniae Isolates Causing Bacteremia

Clin Infect Dis. 2000 Mar;30(3):473-8. doi: 10.1086/313719.

Abstract

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.

MeSH terms

  • Anti-Infective Agents / pharmacology*
  • Bacteremia / epidemiology*
  • Bacteremia / microbiology
  • Ciprofloxacin / pharmacology*
  • Cross Infection / microbiology
  • Drug Resistance, Microbial / genetics
  • Female
  • Humans
  • Klebsiella Infections / epidemiology*
  • Klebsiella Infections / microbiology
  • Klebsiella pneumoniae / drug effects*
  • Klebsiella pneumoniae / enzymology
  • Klebsiella pneumoniae / genetics
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • beta-Lactamases / biosynthesis*
  • beta-Lactamases / genetics

Substances

  • Anti-Infective Agents
  • Ciprofloxacin
  • beta-Lactamases