Extended Spectrum Beta-lactamases in Gram-negative Sepsis
Escherichia coli, Klebsiella pneumoniae, and other enteric Gram-negative bacilli are commonly associated with sepsis. Bacteremia caused by such organisms may arise from infections of the urinary tract, the gastrointestinal tract and peritoneal cavity, the lungs, and less commonly from central venous lines and wounds. In many hospitals, at least one third of E. coli strains and greater than 95% of K. pneumoniae strains are resistant to ampicillin. This resistance is usually mediated in E. coli by a plasmid mediated β-lactamase known as TEM-1 and in K. pneumoniae by a chro-mosomally encoded β-lactamase known as SHV-1 (TEM refers to Temoneira, a patient from Athens, Greece, from whom a urinary tract isolate of E. coli bearing the TEM-1 β-lactamase was first isolated in the 1960s. SHV refers to sulfhydryl variable, in reference to the interaction of SHV-1 with p-chloromercuribenzoate). Both TEM-1 and SHV-1 can mediate resistance to ampicillin and first generation cephalosporins, but not to the third generation cephalosporins.
KeywordsKlebsiella Pneumoniae Antimicrob Agent Clavulanic Acid Generation Cephalosporin ESBL Production
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