Infections of cefotaxime-resistant and cefmetazole-susceptible Escherichia coli and Klebsiella pneumoniae in children

Tsung-Zu Wu¹, Po-Ren Hsueh², Luan-Yin Chang³, Chun-Yi Lu³, Chung-Yi Wang³, Chin-Ying Yang³, Pei-Lan Shao³, Ping-Ing Lee³, Chin-Yun Lee³, Li-Min Huang^3
1Department of Pediatrics, Women's and Children's Hospital, Taipei; and Departments of ²Laboratory Medicine and Internal Medicine, and ³Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

Received: August 4, 2003 Revised: October 5, 2004 Accepted: October 18, 2004

Corresponding author: Li-Min Huang, Department of Pediatrics, National Taiwan University Hospital, No. 7 Chung-Shan South Road, , Taiwan. E-mail:

A search of the computerized database at the National Taiwan University Hospital was made for cefotaxime-resistant and cefmetazole-susceptible isolates of Escherichia coli and Klebsiella pneumoniae (which may be extended-spectrum ?-lactamase-producing strains) in pediatric wards and intensive care units between 1999 and 2001. Fourteen infectious episodes attributed only to study bacteria were identified, including 7 episodes of bacteremia. Nine patients (64.3%) had underlying medical conditions: 3 were premature babies, 3 were immunodeficient, 2 had malignancy, and 2 had a congenital heart disease with active heart failure even after surgery. Among the 7 patients with bacteremias, 5 may be catheter-related; 6 were treated with carbapenems and 1 was treated with cefmetazole successfully, with or without the removal of the catheter. Before the acquisition of the infection, a history of stay in an intensive care unit within 4 weeks was noted in 10 cases (71.4%); a history of use of extended-spectrum cephalosporins within 4 weeks was also noted in 6 cases (42.9%). Cefmetazole, with or without an aminoglycoside, was clinically effective in 6 cases (42.8%). Except for 1 episode of pneumonia that ended in mortality, all of the infectious episodes were successfully treated. The mortality rate was 7.1%.

Key words: Beta-lactam resistance, beta-lactamases, cefmetazole, E.coli, K. pneumoniae, treatment outcome

J Microbiol Immunol Infect2005;38:112-116.