2003 Volume 51 Issue 6 Pages 347-351
A 63-year-old man with a history of severe acute pyelonephritis due to extended-spectrum β-lactamase (ESBL) producing isolate was admitted hospital July 30, 2002, with blunt thoracic injury. His history and family history were unremarkable. He underwent indwelling thoracic tube drainage for hemopneumothorax, and epidural intubation for a rib fracture pain. He was given cefazolin for antimicrobial prophylaxis. On hospital day 12, he had a temperature of 38.8°C after urinary catheter insertion. He developed a persistent fever with chills. Escherichia coli were isolated in cultures of blood and urine specimens on August 14, 2002. The result of antibiotic susceptibility against isolates predicted the presence of ESBL producing strain. He was Immediately treated for 6 days with tazobactam/piperacillin (TAZ/PIPC) (0.3g/2g×2/day) iunder a diagnosis of acute pyelonephritis. TAZ/PIPC was effective, but 7 days after treatment was stopped, he underwent a relapse. He was treated for 10 days again. With TAZ/PIPC, resolved the urinary tract infection. He was discharged September 18, 2002. The results of PCR and Sequence showed that ESBL was UOE-2 (CT-XM-14). Results of DNA restriction fragment length polymorphism by pulse fi eld gel electrophoresis showed that the 2 isolates, one from the first infection, and the other from the relapse, were the same clone. TAZ/PIPC is effective for treating urinary tract infections with ESBL producing E. coli. The occurrence of infections caused by ESBL-producing strains thus require consideration in such cases.
