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Antimicrobial Agents and Chemotherapy, September 2006, p. 3179-3182, Vol. 50, No. 9
0066-4804/06/$08.00+0     doi:10.1128/AAC.00218-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Endocarditis Caused by Extended-Spectrum-ß-Lactamase-Producing Klebsiella pneumoniae: Emergence of Resistance to Ciprofloxacin and Piperacillin-Tazobactam during Treatment despite Initial Susceptibility

Oren Zimhony,1* Inna Chmelnitsky,3 Rita Bardenstein,1 Sorel Goland,2 Orly Hammer Muntz,3 Shiri Navon Venezia,3 and Yehuda Carmeli3

Infectious Diseases Division,1 Cardiology Division, Kaplan Medical Center Rehovot, Hebrew University and Hadassah, Jerusalem,2 Division of Epidemiology, Molecular Epidemiology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel3

Received 20 February 2006/ Returned for modification 20 March 2006/ Accepted 24 June 2006

Three episodes of bacteremia occurred in the course of prosthetic valve endocarditis caused by an extended-spectrum-ß-lactamase (ESBL)-producing Klebsiella pneumoniae strain. The second isolate developed resistance to ciprofloxacin and the third isolate to piperacillin-tazobactam (PIP-TZ) following sequential therapy with each agent. The first isolate was resistant to PIP-TZ only at high inocula, the second isolate acquired increased transcription of the acrA gene, and the third isolate became resistant to PIP-TZ due to loss of ß-lactamase inhibition by TZ. We question if and how PIP-TZ susceptibility should be reported for ESBL-producing Enterobacteriaceae.

* Corresponding author. Mailing address: Division of Infectious Diseases, Kaplan Medical Center Rehovot, Hebrew University and Hadassah, P.O. Box 1, Rehovot 76100, Israel. Phone: 972-8-9441993. Fax: 972-8-9441765. E-mail: oren_z{at}clalit.org.il.

Antimicrobial Agents and Chemotherapy, September 2006, p. 3179-3182, Vol. 50, No. 9
0066-4804/06/$08.00+0     doi:10.1128/AAC.00218-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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