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i am presently on klebsiella pneumoniae, i have taken all clinical isolates from different sources.its suceptibility by Disk diffusion test & MIC were performed.i am using different drugs including cephalosporins & Flouroquinolones.The mic values for gatifloxacine , o floxacine , Nalidixic acid , cefeclor , cefotoxime , ceftrixone are more tha 256 micrograms/ml .what may the posiible reason? it must be noted that majority of thaes are ESBL positive.
Adnan Amin
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There are several possible explanations for the multiple drug resistance pattern of this isolate. It could be an ESBL producer, an AmpC producer, or a metallo-beta-lactamase producer. It could have more than one of these resistance mechanisms, each encoded on a multidrug resistance plasmid. In addition K. pneumoniae has a propensity to have reduced outer membrane permeability. It would be necessary to do phenotypic confirmatory tests and possibly even molecular testing to determine the actual resistance mechanisms. You could try ESBL testing based on cefepime and clavulanate, one of the several published AmpC tests, and one of the published chelator-based tests for metallo-beta-lactamase production. These tests have been published in the Journal of Clinical Microbiology - search for authors J. Black (AmpC), Y. Arakawa (AmpC, metallo-beta-lactamase), and T. Walsh (metallo-beta-lactamase ).
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