Failure of Ciprofloxacin Therapy in the Treatment of Community-Acquired Acute Pyelonephritis caused by In-Vitro Susceptible Escherichia coli Strain Producing CTX-Type Extended-Spectrum β-Lactamase / 감염과화학요법
Infection and Chemotherapy
;
: 357-361, 2018.
Artigo
em Inglês
| WPRIM
| ID: wpr-722309
ABSTRACT
While carbapenems are the drug of choice to treat extended-spectrum-β-lactamase (ESBL)-producing strains, some alternative carbapenem-sparing regimens are suggested for antibiotic stewardship. We experienced a case of ciprofloxacin treatment failure for acute pyelonephritis caused by an apparently susceptible Escherichia coli. A 71-year-old woman presented the emergency department with fever for 7 days and bilateral flank pain for 2 days. The laboratory results and abdominopelvic computed tomography finding were compatible with acute pyelonephritis. During 3-day ciprofloxacin therapy, the patient remained febrile with persistent bacteremia. After the change in antibiotics to ertapenem, the patient’s clinical course started to improve. ESBL-producing E. coli isolates were identified in all three consecutive blood samples. Pulsed-field gel electrophoresis (PFGE) patterns, serotypes, and sequence types showed the three isolates were derived from the identical strain. The isolates produced CTX-M-14 type ESBL belonging to the ST69 clonal group. Despite in vitro susceptibility, the failure was attributed to a gyrA point mutation encoding Ser83Leu within quinolone resistance-determining regions. This case suggests that ciprofloxacin should be used cautiously in the treatment of serious infections caused by ciprofloxacin-susceptible, ESBL-producing E. coli, even in acute pyelonephritis because in-vitro susceptibility tests could fail to detect certain genetic mutations.
Texto completo:
DisponíveL
Índice:
WPRIM (Pacífico Ocidental)
Assunto principal:
Pielonefrite
/
Técnicas In Vitro
/
Ciprofloxacina
/
Carbapenêmicos
/
Eletroforese em Gel de Campo Pulsado
/
Bacteriemia
/
Falha de Tratamento
/
Mutação Puntual
/
Dor no Flanco
/
Serviço Hospitalar de Emergência
Tipo de estudo:
Estudo prognóstico
Limite:
Idoso
/
Feminino
/
Humanos
Idioma:
Inglês
Revista:
Infection and Chemotherapy
Ano de publicação:
2018
Tipo de documento:
Artigo
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