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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

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.

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