Évaluation de la sensibilité à la lévofloxacine des souches isolées d'infections urinaires basses communautaires

[Epidemiological study of Klebsiella spp. uropathogenic strains producing extended-spectrum β-lactamase in a Tunisian university hospital, 2009]

OBJECTIVE

An update on the prevalence of antibiotic resistance in extended-spectrum β-lactamase among urinary strains of Klebsiella spp. isolated from in-come and out-come patients at University Hospital, Mahdia (Tunisia).

PATIENTS AND METHODS

A retrospective survey was made over a period of twelve months (year 2009). It focused on 3564 patients with urinary tract infection confirmed by the Laboratory of Microbiology in the University Hospital, Mahdia.

RESULTS

Klebsiella spp. was involved in 5.5% (198/3564) of all cases of urinary tract infections identified. Klebsiella pneumoniae accounted for 94.9% of all Klebsiella (5.1% for Klebsiella oxytoca). The frequency of Klebsiella spp. resistance to fluoroquinolones was 19.2% and to third generation cephalosporins was 22.7%. Forty strains of Klebsiella spp. producing extended-spectrum β-lactamase witch corresponds to 20.2% of all the Klebsiella. The extended-spectrum β-lactamase strains with resistance to fluoroquinolones were 67.5% (27/40) or 13.6% of all klebsiella (27/198). No strain was resistant to imipenem. The 27 strains multiresistant (ESBL+FQ resistance) are likely to be carriers of plasmids encoding the ESBL and resistance to fluoroquinolones.

CONCLUSION

the resistance of Enterobacteriaceae, including Klebsiella spp, to fluoroquinolones has become a concern both in hospital in community medicine. The advent of this resistance mechanism involves a more rational use of fluoroquinolones, especially as first-line treatment of urinary tract infections.

Ciprofloxacin and norfloxacin pharmacokinetics and prostatic fluid penetration in dogs after multiple oral dosing

The aims of this study were to assess the pharmacokinetics and pharmacokinetic/pharmacodynamic (PK/PD) indices predictive of clinical outcome of ciprofloxacin (CIP) and norfloxacin (NOR) after multiple oral dosing, and to investigate their penetration into prostatic fluid in dogs. Eight dogs received seven oral doses b.i.d. of NOR (20 mg/kg) and CIP (15 mg/kg). Drug concentrations were determined in blood and in two prostatic fluid samples. Prostatic fluid concentrations were lower than plasma concentrations for both drugs. No statistically significant differences were determined between the pharmacokinetic parameters calculated after the first and seventh doses for either CIP or NOR. The PK/PD indices were found to be useful for predicting bacteriological outcome for fluoroquinolones (area under the disposition curve/minimum inhibitory concentration [MIC] and peak plasma concentration/MIC) and indicate that with this dose regimen CIP presents a more favourable disposition than NOR for successful clinical outcome.