1410. Ertapenem-Resistant Klebsiella spp. Isolates with OXA-48 Carbapenemase from Kocaeli, Turkey
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Background:There have been a rapid increase in OXA-48 type carbapenemase producing Klebsiella spp.  at worldwide. This is the first report of  ertapenem-resistant Klebsiella spp.producing OXA-48 from Kocaeli region of Turkey. 

Methods: Ertapenem- resistant Klebsiella spp. isolates ( 8 K.pneumoniae and 2 K.oxytoca) obtained from blood cultures of 10 patients were identified from March 2009 to December 2010. The Minimum inhibitory concentrations (MIC) were tested using by agar dilution method. Beta-lactamase extracts were obtained by sonication and were analyzed by isoelectric focusing. The presence of OXA-48 carbapenemase in all isolates were confirmed by PCR and sequencing.

Results:MIC values of OXA-48 producing Klebsiella  isolates are shown in table 1. Patients characteristics  are shown in table 2. Recurrent bacteremia was determined at only one patient who was treated with meropenem monotherapy who eventually died.  

Conclusion: The findings indicate that ertapenem resistance may include the first signs of  carbapenem resistance related with OXA-48 among Klebsiella spp.. Combination therapy may be an appropriate option in OXA-48 producing Klebsiella spp. infections.

Table 1. MIC values of isolates

 Case no

Ceftazidime

Tigecycline

Piperacillin-

tazobactam

Doripenem

Cefepime

Colistin

Amikacin

Ciprofloxacin

Ertapenem

Imipenem

Meropenem

1

64

2

>128

2

64

2

<0,5

2

4

2

<0,5

2

64

4

>128

2

16

2

16

128

4

2

<0,5

3

64

2

>128

4

64

2

<0,5

2

4

4

<0,5

4

128

4

>128

2

64

2

8

128

4

2

<0,5

5

64

4

>128

32

128

2

2

128

64

16

16

6

64

8

>128

16

64

4

16

128

32

16

4

7

64

8

>128

16

128

4

16

128

32

16

4

8

8

4

>128

2

32

2

16

<0,5

4

4

<0,5

9

16

8

>128

8

64

4

16

<0,5

8

4

2

10

16

16

>128

4

64

4

16

<0,5

8

4

2

 Table2. Characteristics of patients

Sex

Age (years)

Service

Microorganism

Treatment

Outcome

F

1

Pediatric onkology

K.oxytoca

MEM+ AK

S

F

1

Pediatric surgery

K.pneumoniae

MEM

died

M

59

Gastroenterology

K.oxytoca

MEM+ AK

S

F

NB

Neonatal ICU

K.pneumoniae

MEM+ AK

S

M

NB

Neonatal ICU

K.pneumoniae

MEM+ AK

S

F

NB

Pediatric surgery

K.pneumoniae

Piperacillin-tazobactam+ AK

S

F

47

Adult ICU

K.pneumoniae

Tigecycline+sulperazon

S

F

49

Adult ICU

K.pneumoniae

DOR+AK

S

M

31

Adult ICU

K.pneumoniae

DOR+AK

S

F

44

Adult ICU

K.pneumoniae

DOR+ ciprofloxacin

S

F: Female, M: Male, NB: Newborn, ICU: Intensive care unit, MEM: Meropenem, AK: Amikacin, DOR: Doripenem, S: Survived

Meliha Meric, Emel Azak and Haluk Vahaboglu, Department of Infectious Diseases and Clinical Microbiology, Kocaeli University, Medical Faculty, Kocaeli, Turkey

Disclosures:

M. Meric, None

E. Azak, None

H. Vahaboglu, None

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