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.
Article
in En
| WPRIM
| ID: wpr-722309
Responsible library:
WPRO
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.
Key words
Full text:
1
Database:
WPRIM
Main subject:
Pyelonephritis
/
In Vitro Techniques
/
Ciprofloxacin
/
Carbapenems
/
Electrophoresis, Gel, Pulsed-Field
/
Bacteremia
/
Treatment Failure
/
Point Mutation
/
Flank Pain
/
Emergency Service, Hospital
Type of study:
Prognostic_studies
Limits:
Aged
/
Female
/
Humans
Language:
En
Journal:
Infection and Chemotherapy
Year:
2018
Document type:
Article