ABSTRACT
This study reports on the emergence of OXA-48-like carbapenemases among isolates of Enterobacteriaceae in South Africa. In addition, the emergence during therapy of a colistin-resistant OXA-181-producing Klebsiella pneumoniae isolate was documented following selective digestive tract decontamination with oral colistin, which is therefore strongly discouraged.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Colistin/therapeutic use , Drug Resistance, Bacterial , Enterobacteriaceae Infections/epidemiology , Enterobacteriaceae/enzymology , Gastrointestinal Tract/microbiology , beta-Lactamases/metabolism , Anti-Bacterial Agents/pharmacology , Colistin/pharmacology , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/drug therapy , Humans , Male , Middle Aged , South Africa/epidemiology , beta-Lactamases/geneticsABSTRACT
New, effective antibiotics are only likely to become available in 15 - 20 years. To prevent deaths from untreatable Gram-negative infections in South Africa, the rights of any doctor, whether in general or in hospital practice, to indiscriminately prescribe whatever antibiotic they wish, and in whatever fashion, must be challenged. Furthermore, although prevention of the emergence and subsequent spread of carbapenem-resistant Enterobacteriaceae (CRE) has focused on acute and chronic care facilities and inter alia on antibiotic exposure in these institutions, CRE may soon become an issue within entire communities, highlighting a role for public health authorities in CRE prevention efforts.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/epidemiology , Enterobacteriaceae/drug effects , Infection Control/methods , beta-Lactam Resistance , Anti-Bacterial Agents/pharmacology , Carbapenems/therapeutic use , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/prevention & control , Humans , Population Surveillance , Risk Factors , South Africa/epidemiologyABSTRACT
Four sequential extended-spectrum beta -lactamase-producing isolates of Klebsiella pneumoniae were obtained from a patient after treatment with ertapenem and cultured. The first and fourth isolates were susceptible to ertapenem, whereas the second and third were resistant. All 4 isolates belonged to the same strain and produced a group 1 CTX-M enzyme; additionally, the resistant isolates had lost a porin.