Infections by OXA-48-like-producing Klebsiella pneumoniae non-co-producing extended-spectrum beta-lactamase: Can they be successfully treated with cephalosporins?. (December 2019)

• Record Type: Journal Article
• Authors: Escolà-Vergé, Laura; Larrosa, Nieves; Los-Arcos, Ibai; Viñado, Belen; González-López, Juan José; Pigrau, Carles; Almirante, Benito; Len, Oscar
• Is Part Of: Journal of global antimicrobial resistance. Volume 19(2019)
• Page Start: 28
• Page End: 31
• Publication Date: 2019-12
• Subjects: Carbapenemase -- Cephalosporins -- Extended-spectrum-β-lactamase (ESBL) -- Klebsiella pneumoniae -- OXA-48; Drug resistance -- Periodicals; Drug resistance -- Periodicals; Drug resistance; Periodicals; 616.9041
• DOI: 10.1016/j.jgar.2019.02.016
• Languages: English
• ISSNs: 2213-7165

Abstract

Highlights: OXA-48-like carbapenemases have low hydrolytic activity against cephalosporins. Ceftazidime is active against OXA-48-like producers lacking extended-spectrum β-lactamases (ESBL) in animal models. Cephalosporins were effective to treat ESBL-negative OXA-48-producing K. pneumoniae infections. However, further clinical studies should be performed to investigate this issue. Abstract: Background: OXA-48 is an Ambler class D β-lactamase that hydrolyses penicillin and imipenem but has poor hydrolytic activity against cephalosporins. However, very few clinical experiences of treating extended-spectrum β-lactamase (ESBL)-negative OXA-48 producers with cephalosporins have been published. Objectives: The aim of this study was to report clinical experience of infections due to ESBL-negative OXA-48-producing Klebsiella pneumoniae ( K. pneumoniae ) treated with cephalosporins. Patients and methods: A retrospective study was conducted at Vall d'Hebron University Hospital, in Barcelona (Spain). It reviewed all microbiological isolates of OXA-48-producers that did not co-produce ESBL from May 2014 to May 2017, and included only clinical strains of patients treated with a cephalosporin for ≥72 h. Results: From the 75 isolations of OXA-48 producers, there were 17 isolations of ESBL-negative OXA-48-producing K. pneumoniae . Three patients were treated with cephalosporins with successful outcomes: a pneumonia in a neutropenic patient treated with cefepime and amikacin; an acute focal nephritis of a renal graft treated with ceftriaxone; and an intrabdominal post-surgical infection treated with cefepime in combination with tigecycline at the beginning, and ciprofloxacin afterwards. Conclusions: Cephalosporins could be an alternative treatment in selected patients with ESBL-negative OXA-48-producing K. pneumoniae infections, especially to avoid carbapenem use. However, it remains unknown if they should be given in combination.