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Journal of Clinical Microbiology, December 1999, p. 4020-4027, Vol. 37, No. 12
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
Bacteremia Due to Extended-Spectrum
-Lactamase-Producing Escherichia coli and
Klebsiella pneumoniae in a Pediatric Oncology Ward: Clinical
Features and Identification of Different Plasmids Carrying both SHV-5
and TEM-1 Genes
L. K.
Siu,1
Po-Liang
Lu,2
Po-Ren
Hsueh,2,3
F. M.
Lin,1
Shan-Chwen
Chang,2,*
Kwen-Tay
Luh,2,3
Monto
Ho,1 and
Chin-Yun
Lee4
Division of Clinical Research, National
Health Research Institute,1 and
Departments of Internal Medicine,2
Laboratory Medicine,3 and
Pediatrics,4 National Taiwan University
Hospital, Taipei, Taiwan
Received 14 June 1999/Returned for modification 12 August
1999/Accepted 15 September 1999
Thirteen patients who had 16 episodes of bacteremia were observed
between 1993 and 1997 in a pediatric oncology ward with a high
background isolation rate of cefotaxime- or aztreonam-resistant gram-negative bacteria. Four blood isolates were Escherichia
coli and 12 were Klebsiella pneumoniae, and these
isolates harbored extended-spectrum
-lactamases (ESBLs). All
episodes of bacteremia were nosocomial, all except one of the episodes
occurred in neutropenic patients, and all patients were treated with
piperacillin or ceftazidime with amikacin and cefazolin prior to the
onset of bacteremia. Nine of 13 patients were receiving
extended-spectrum
-lactam treatment when the bacteremias caused by
ESBL producers occurred. Molecular studies revealed that four K. pneumoniae SHV-2-producing isolates from 1994 were of the same
clone. Other ESBL producers, including six that carried both TEM-1 and
SHV-5, five that carried SHV-5, and one that carried SHV-2 alone, were
unrelated. In conclusion, SHV-5 was present in 11 of the 16 isolates
and coexisted with TEM-1 in 6 isolates. Acquisition of resistance genes
probably occurred under antibiotic selection pressure. This study
highlights the importance of routine checks for and detection of ESBL
producers. Effective therapy against ESBL producers should be
considered early for children who have malignancies and neutropenia and
who are septic, despite treatment with a regimen that includes an extended-spectrum
-lactam, in a clinical setting of an increased incidence of ESBL-producing bacteria.
*
Corresponding author. Mailing address: Department of
Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Rd., Taipei, Taiwan. Phone: 886-2-2397-0800, ext. 5045. Fax:
886-2-2397-1412. E-mail:
sc4030{at}ha.mc.ntu.edu.tw.
Journal of Clinical Microbiology, December 1999, p. 4020-4027, Vol. 37, No. 12
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
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