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עמוד בית
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May 2005
J. Bishara, G. Livne, S. Ashkenazi, I. Levy, S. Pitlik, O. Ofir, B. Lev and Z. Samra

Background: The prevalence of extended-spectrum β-lactamase-producing organisms and their antimicrobial resistance patterns may vary between geographic areas.

Objectives: To evaluate the prevalence and susceptibility of ESBL[1]-producing organisms among Klebsiella pneumoniae and Escherichia coli isolated from adult and pediatric patients in two Israeli hospitals.

Methods: ESBL production was tested according to recommendations of the Clinical and Laboratory Standards Institute, using ceftazidime (30 μg) and a combination of ceftazidime/clavulanate (30/10 μg) disks with a ≥5 mm difference indicating positivity. Antibiotic susceptibilities were determined by the disk diffusion method according to CLSI[2] standards. Minimum inhibitory concentrations were determined by the E-test.

Results: The prevalence of ESBL-producing organisms was significantly higher among K. pneumoniae than E. coli isolates – 32% (241/765) vs. 10% (57/547) respectively (P < 0.001), and more frequently isolated from adults than children (odds ratio 2.27 for K. pneumoniae and 12.94 for E. coli). Resistance rates for amoxicillin/clavulanate, piperacillin-tazobactam, amikacin, and ciprofloxacin among the ESBL-producing K. pneumoniae and E. coli isolates were 95%, 82%, 49% and 77% for K. pneumoniae, and 77%, 35%, 25% and 100% for E. coli. Two (0.8%) ESBL-producing and 4 (0.7%) ESBL-negative K. pneumoniae isolates showed intermediate susceptibility (MIC[3] 6 μg/ml) to meropenem. All isolates were sensitive to ertapenem and colistin.  

Conclusion: ESBL production among K. pneumoniae and E. coli is more prevalent in the adult population than the pediatric population and is associated with multidrug resistance.

[1] ESBL = extended spectrum β-lactamase

[2] CLSI = Clinical and Laboratory Standards Institute (formerly the NCCLS)

[3] MIC = minimum inhibitory concentration


December 2000
Aliza Noy, MD, Ruth Orni-Wasserlauf, MD, Patrick Sorkine, MD and Yardena Siegman-Igra, MD, MPH.
 Background: An increase in multiple drug-resistant Klebsiella pneumoniae due to extended spectrum -lactamase production has recently been reported from many centers around the world. There is no information in the literature regarding this problem in Israel. A high prevalence of ceftazidime-resistant K. pneumoniae was noted in our Intensive Care Unit in the first few months of 1995.

Objective: To describe the epidemiology of ceftazidime-resistant K. pneumoniae in our medical center, as representing the situation in tertiary care hospitals in Israel.

Methods: We vigorously restricted the use of ceftazidime in the ICU and enforced barrier precautions. The susceptibility rate of K. pneumoniae was surveyed in the ICU and throughout the hospital before and after the intervention in the ICU.

Results: Following the intervention, the susceptibility rate of K. pneumoniae increased from 11% (3/28) to 47% (14/30) (P0.01) among ICU isolates, from 55% (154/280) to 62% (175/281) (P=0.08) among total hospital isolates, and from 61% (50/82) to 74% (84/113) (P0.05) among total hospital blood isolates, although no additional control measures were employed outside the ICU.

Conclusions: The epidemiology of ceftazidime-resistant K. pneumoniae in our medical center is similar to that reported from other centers around the world. Early awareness to the emergence of this resistance, identification of the source of the epidemic, and prompt action at the putative source site may reduce the rate of acquisition and spread of such resistance inside and outside of the source unit.

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