This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Szabó, D.
Right arrow Articles by Paterson, D. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Szabó, D.
Right arrow Articles by Paterson, D. L.

 Previous Article  |  Next Article 

Journal of Clinical Microbiology, October 2005, p. 5058-5064, Vol. 43, No. 10
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.10.5058-5064.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

SHV-Type Extended-Spectrum Beta-Lactamase Production Is Associated with Reduced Cefepime Susceptibility in Enterobacter cloacae

Dóra Szabó,1,2 Robert A. Bonomo,3 Fernanda Silveira,1 A. William Pasculle,4 Carla Baxter,4 Peter K. Linden,5 Andrea M. Hujer,3 Kristine M. Hujer,3 Kathleen Deeley,1 and David L. Paterson1*

Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213,1 Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary,2 Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio 44106,3 Clinical Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213,4 Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 152135

Received 4 June 2005/ Returned for modification 5 July 2005/ Accepted 18 July 2005

Cefepime is a potentially useful antibiotic for treatment of infections with Enterobacter cloacae. However, in our institution the MIC90 for E. cloacae bloodstream isolates is 16 µg/ml. PCR amplification of bla genes revealed that one-third (15/45) of E. cloacae bloodstream isolates produced SHV-type extended-spectrum beta-lactamases (ESBLs) in addition to hyperproduction of AmpC-type beta-lactamases. The majority (11/15) of ESBL producers also produced the TEM-1 beta-lactamase. The SHV types included SHV-2, -5, -7, -12, -14, and -30. All but two of the ESBL-producing E. cloacae isolates, but none of the non-ESBL-producing strains, had MICs of cefepime of ≥2 µg/ml. The MIC90 for cefepime for ESBL-producing strains was 64 µg/ml, while for non-ESBL producers it was 0.5 µg/ml. Using current Clinical and Laboratory Standards Institute breakpoints for cefepime, two thirds (10/15) of ESBL-producing isolates would have been regarded as susceptible to cefepime. Phenotypic ESBL detection methods were generally unreliable with these E. cloacae isolates. Based on these results, pharmacokinetic, pharmacodynamic, and clinical reevaluation of cefepime breakpoints for E. cloacae may be prudent.

* Corresponding author. Mailing address: UPMC Division of Infectious Diseases, Suite 3A Falk Medical Building, 3601 5th Avenue, Pittsburgh, PA 15213. Phone: (412) 648-6478. Fax: (412) 648-6399. E-mail: patersond{at}dom.pitt.edu.

Journal of Clinical Microbiology, October 2005, p. 5058-5064, Vol. 43, No. 10
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.10.5058-5064.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Petersen, P. J., Jones, C. H., Venkatesan, A. M., Bradford, P. A. (2009). Efficacy of Piperacillin Combined with the Penem {beta}-Lactamase Inhibitor BLI-489 in Murine Models of Systemic Infection. Antimicrob. Agents Chemother. 53: 1698-1700 [Abstract] [Full Text]  
  • Jones, C. H., Ruzin, A., Tuckman, M., Visalli, M. A., Petersen, P. J., Bradford, P. A. (2009). Pyrosequencing Using the Single-Nucleotide Polymorphism Protocol for Rapid Determination of TEM- and SHV-Type Extended-Spectrum {beta}-Lactamases in Clinical Isolates and Identification of the Novel {beta}-Lactamase Genes blaSHV-48, blaSHV-105, and blaTEM-155. Antimicrob. Agents Chemother. 53: 977-986 [Abstract] [Full Text]  
  • Endimiani, A., Carias, L. L., Hujer, A. M., Bethel, C. R., Hujer, K. M., Perez, F., Hutton, R. A., Fox, W. R., Hall, G. S., Jacobs, M. R., Paterson, D. L., Rice, L. B., Jenkins, S. G., Tenover, F. C., Bonomo, R. A. (2008). Presence of Plasmid-Mediated Quinolone Resistance in Klebsiella pneumoniae Isolates Possessing blaKPC in the United States. Antimicrob. Agents Chemother. 52: 2680-2682 [Abstract] [Full Text]  
  • Turnidge, J., Paterson, D. L. (2007). Setting and Revising Antibacterial Susceptibility Breakpoints. Clin. Microbiol. Rev. 20: 391-408 [Abstract] [Full Text]  
  • Apfalter, P., Assadian, O., Daxbock, F., Hirschl, A. M., Rotter, M. L., Makristathis, A. (2007). Extended double disc synergy testing reveals a low prevalence of extended-spectrum {beta}-lactamases in Enterobacter spp. in Vienna, Austria. J Antimicrob Chemother 59: 854-859 [Abstract] [Full Text]  
  • Szabo, D., Silveira, F., Hujer, A. M., Bonomo, R. A., Hujer, K. M., Marsh, J. W., Bethel, C. R., Doi, Y., Deeley, K., Paterson, D. L. (2006). Outer Membrane Protein Changes and Efflux Pump Expression Together May Confer Resistance to Ertapenem in Enterobacter cloacae.. Antimicrob. Agents Chemother. 50: 2833-2835 [Abstract] [Full Text]  


Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»