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Semin Respir Crit Care Med 2000; 21(4): 323-330
DOI: 10.1055/s-2000-9856
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Therapeutic Considerations in the Treatment of Respiratory Infections Caused by Ceftazidime-Resistant Klebsiella Pneumoniae

Louis B. Rice
  • VA Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
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Publication History

Publication Date:
31 December 2000 (online)

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ABSTRACT

Klebsiella pneumoniae are important human pathogens, particularly as causes of nosocomial respiratory tract infections. Intrinsically resistant to ampicillin, in recent years K. pneumoniae strains have acquired resistance to a broad variety of extended-spectrum cephalosporins. This resistance is most commonly mediated by the extended-spectrum β-lactamases (ESBLs), plasmid-mediated enzymes that have evolved through point mutations in the genes encoding the more susceptible penicillinases TEM-1 and SHV-1. In a small minority of cases, K. pneumoniae have also been found to express extended-spectrum cephalosporin resistance by the elaboration of plasmid-mediated AmpC-type enzymes. These mutant enzymes confer resistance to extended-spectrum cephalosporins, penicillins, and in some cases cefamycins or β-lactam-β-lactamase inhibitor combinations. The most reliable and effective antimicrobial treatment of infections caused by these strains are the carbapenems imipenem and meropenem.

KEYWORD

Klebsiella pneumoniae, nosocomial respiratory tract infections - ESBLs

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