Tazobactam piperacillin ESBL

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1 ESBL Tazobactampiperacillin ESBL TazobactampiperacillinTAZPIPC ESBL Escherichia coli cefazolin ESBL ESBL TAZPIPC2.5 g TAZPIPC 1 TAZPIPC2.5 g lactamase UOE 2CTX M 14 ESBL TEM 1 TAZPIPC ESBL ESBL ESBL Key words: ESBLextended spectrum lactamase Escherichia coli 1 E. coli 2 E. coli 2 lactamaseesbl 2 UOE 2 CTX M 14ESBL E. coli ESBL E. coli I mg Rec Rec E. coli UOE 2 E. coli Rec

2 Rec 2002 Vitek system MIC 2000 NCCLS 4 3 lactamase ESBL primeruoe 2: gtgacaaagagagtgcaacggggctctctgcgttctg- TTgCTEM:TAAgAgAATTATgCAgTgCTgCCggTC- TgACAgTTACCAATgC Sequece primer UOE 2 : AAAAAACACACgTggAATTTAgg ATCTgATCCTTCAACTCAgC TEM : CCgCTCATgATACAATAACCCATATgAgTAAACTTggTCTgACAg PCR product ABI 377 sequencer 4 E. coli 4 DNA Smith 5 Not Xba Bio Rad Cheff Mapper 200 V pulse time initial time 3 secfinal time 60 sec14 22 h II 1 1 cefazolincez 2g Fig Fr 8 14 E. coli piperacillinpipc64cez 16cefotaximeCTX32cefmetazole 4aztreonam 16 ml ESBL TazobactampiperacillinTAZPIPC ESBL E. coli TAZPIPC 2.5 g TAZPIPC 7 ciprofloxacincpfx200 mg CPFX 300 mg E. coli levofloxacin Temperature /30 8/6 8/16 8/21 8/31 9/2 9/3 9/12 CEZ 2g2/d d.i. TAZ/PIPC 2.5g2/d d.i. CPFX 600mg/d p.od.i. TAZ/PIPC 2.5g2/d d.i. 35 7/30 8/2 8/10 8/13 8/15 8/20 8/25 8/27 8/30 9/5 9/ thoracic tube drainage urinary catheter insertion epidural intubation Cultures of urin specimens E. coli E. coliesbls Cultures of blood specimens E. coliesbls negative negative WBCmm 3 /CRPmg/dL 7,180/2.71 6,690/ ,300/2.43 7,910/0.79 CEZ:cefazolin, TAZ/PIPC: tazobactam/piperacillin, CPFX: ciprofloxacin Fig1. Clinical course of the patient with acutepyelonephritiscaused by ESBL producing Escherichia coli Indomethacin suppository 50 mg

ESBL Antimicrobial agent Table 1MICs of antimicrobials for Escherichia coli isolates from patient with pyelonephritis MICµgmLfor Antimicrobial MICµgmLfor Rec 1847 Rec 2132 agent Rec 1847 Rec 2132

3 ESBL Antimicrobial agent Table 1MICs of antimicrobials for Escherichia coli isolates from patient with pyelonephritis MICµgmLfor Antimicrobial MICµgmLfor Rec 1847 Rec 2132 agent Rec 1847 Rec 2132 Piperacillin Faropenem 1 1 Piperacillin tazobactam Imipenem Ampicillin Cefpodoxime Ampicillin sulbactam Cefpodoxime 1 1 clavulanic acid Amoxicillin Amoxicillin clavulanic acid Trimethoprim sulfamethoxazole Cefazolin Levofloxacin Cefotiam Ciprofloxacin Cefotaxime Fosfomycin Ceftrazidime 2 2 Tetracycline 2 2 Cefpirome Minocycline 1 1 Cefmetazole 4 2 Gentamicin 2 2 Flomoxef Amikacin Aztreonam 8 8 Isepamicin µmml of clavulanic acid added MIC 16 ml 93 TAZPIPC 2.5 g CRP E. coli Table 1 Cefpodoxime MIC 256 ml lactamase clavulanic acidcva4 ml MIC 1 ml ESBL CEZTAZPIPCCPFX MIC ml Ceftazidime MIC 2 mlctx MIC 64 ml CTX M type lactamase 2 lactamase PCR UOE 2CTX M 14type lactamase primer TEM type lactamase primer UOE 2 type TEM type Sequence primer PCR UOE 2 type TEM DNA E. coli 2 Xba DNA Fig2. Xbarestriction patterns of chromosomal DNAs from UOE 2 producing Escherichia coli isolates. M λ DNA ladders; ARec 1446; BRec 2002; CRec 1847 from blood; DRec 2132 from urine.

4 Fig2 2 UOE 2 E. coli 2 Not 2 III E. coli ESBL Winokur ESBL E. coli E. coli 5 78 Yagi E. coli ESBL genotype E. coli Toho 1 SHV ESBL E. coli ESBL CRP ESBL E. coli ESBL lactam lactamase sulbactamtaz ESBL TAZPIPC MIC 4 ml TAZPIPC 7 TAZPIPC 6 ESBL E. coli TAZ PIPC 10 lactam ESBL E. coli fluoroquinolone lactamase sultamicillinamoxicillincva trimethoprimsufamethoxazole MIC ml faropenem fosfomycin MIC ml 2 UOE 2 type lactamase ESBL ESBL ESBL ESBL ESBL ESBL 1 : 47: Yagi TKurokawa HShibata Net al.: A preliminary survey of extended spectrum lactamases ESBLsin clinical isolates of Klebsiella pneumoniae and Escherichia coli in Japan. FEMS MIcrobiol Lett 184: Muratani TTakahashi KMatsumoto T: Prevalence of UOE 2which is TOHO 2 like a novel lactamaseproducing Escherichia coli in Fukuoka Japan. Abstr C p In Abstracts of the 41 st Interscience Conference on Antimicrobial Agents and Chemotherapy. American Society for MicrobiologyChicagoUSA National Committee for Clinical Laboratory Standards: M 7 A 5Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; Approved standard fifth edition2000 M 100 S 11Performance Standards for Antimicrobial Susceptibility Testing12 th Informational Supplement. National Committee for Clinical Laboratory StandardsWaynePa., Smith C LCantor C R: Purificationspecific fragmentationand separation of large DNA molecules. Methods Enzymol. 155: Winokur P LCanton RCasellas J Met al.: Variations in the prevalence of stains expressing an extended spectrum lactamase phenotype and characterization of isolates from Europethe Americansand the Western Pacific region. Clin Infect Dis 32 supple 2: S Pai H: The characteristics of extended spectrum lactamases in Korean isolates of Enterobacteriaceae Yonsei Medical Journal. 39: Pai HKim JKwon Yet al.: Characterization of

5 ESBL extended spectrum lactamases in Klebsiella pneumoniae isolated in Korea. Korean J Infect Dis. 29: : lactamaseesbl Escherichia coli : p Acaseofacutepyelonephritis caused by extended spectrum lactamaseesbl producing Escherichia coli eliminated by tazobactampiperacillin Shigehiko Ito 1 Shiro Nakamura 1 Tetsuro Muratani 2 and Tetsuro Matsumoto 2 1 Department of SurgeryKitakyushu Municipal Yahata Hospital Nishi honmachi Yahatahigashi kukitakyushujapan 2 Department of UrologyUniversity of Occupational and Environmental Health A 63 year old man with a history of severe acute pyelonephritis due to extended spectrum lactamase ESBLproducing isolate was admitted hospital July 30, 2002, with blunt thoracic injury. His history and family history were unremarkable. He underwent indwelling thoracic tube drainage for hemopneumothorax, and epidural intubation for a rib fracture pain. He wasgiven cefazolin for antimicrobial prophylaxis. On hospital day 12, he had a temperature of 38.8 after urinary catheter insertion. He developed a persistent fever with chills. Escherichia coli were isolated in cultures of blood and urine specimens on August 14, The result of antibiotic susceptibility against isolates predicted the presence of ESBL producing strain. He was Immediatelytreatedfor6dayswith tazobactampiperacillintazpipc0.3 g 2g2dayiunder a diagnosis of acute pyelonephritis. TAZPIPC was effective, but 7 days after treatment was stopped, he underwent a relapse. He was treated for 10 days again. With TAZPIPC, resolved the urinary tract infection. He was discharged September 18, The results of PCR and Sequence showed that ESBL was UOE 2CT XM 14. Results of DNA restriction fragment length polymorphism by pulse field gel electrophoresis showed that the 2 isolates, one from the first infection, and the other from the relapse, were the same clone. TAZPIPC is effective for treating urinary tract infections with ESBL producing E. coli. The occurrence of infections caused by ESBL producing strains thus require consideration insuchcases.

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