Reactions 1489, p12 - 22 Feb 2014

SCeftriaxone

Treatment failure in Escherichia coli bacteraemia:case report

A 37-year-old woman experienced treatment failure inEscherichia coli bacteraemia while receiving ceftriaxone.

The woman presented with lethargy, dysuria, nausea andchills. Her history included renal transplantation and cellulitis,for which she had started receiving amoxicillin/clavulanic acid2 days earlier. Tests showed neutrophilia, abnormal urinalysisand elevated CRP levels, and blood cultures were collected.She received IV ceftriaxone 1g or 17 mg/kg [frequency notstated]; however, she continued to be bacteraemic. E. coli wasidentified in blood and urine cultures, with all isolates havingsusceptibility to ceftriaxone. The blood culture isolates testedpositive for AmpC; β-lactamase induction was alsodemonstrated.

On hospital day 2, ceftriaxone was switched to meropenem.The woman’s inflammatory markers subsequently improved,and her bacteraemia resolved.

Author comment: "This case demonstrates a failure ofceftriaxone to clear bacteraemia caused by an organism thattested sensitive to ceftriaxone by multiple methods accordingto current [Clinical and Laboratory Standards Institute]breakpoints."Papanicolas LE, et al. Ceftriaxone treatment failure in cephalosporin-susceptibleEscherichia coli bacteraemia. International Journal of Antimicrobial Agents 41:298-299, No. 3, Mar 2013. Available from: URL: http://doi.org/10.1016/j.ijantimicag.2012.11.008 - Australia 803099717

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Reactions 22 Feb 2014 No. 14890114-9954/14/1489-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved