Osteomyelitis of Parietal Bone in Melioidosis

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 13, No. 8, August 2007 1257 ESBLs among Klebsiella spp. ranged between 0.6% and 1.6%. In 2005 and 2006, the rate of ESBL-producing Klebsiella spp. increased to 3.8% (44 isolates) and 4.5% (55 isolates), respectively, and originated mainly from intensive care units (Figure, panel B). In 2005, a single Klebsiella pneumoniae isolate showed reduced susceptibility to imipenem (MIC 2 μg/mL) and to meropenem (MIC 4 μg/mL) and resistance to ertapenem (MIC >16 μg/mL). Nevertheless, production of ESBL by Enterobacteriaceae organisms is still rare in southeast Austria compared with other European countries (6). However, a dramatic increase of ESBL-producing E. coli and Klebsiella spp. has been observed during recent years. The increase of ESBL-producing E. coli isolates in outpatients with urinary tract infections leads to serious treatment problems. Results from a recent study indicate that the increase of ESBL-producers in southeast Austria is caused mainly by the emergence of CTX-M–type ESBLs, which are increasingly being isolated from outpatients (7). The K. pneumoniae isolate found in 2005 represents the fi rst ESBL-producing isolate not susceptible to carbapenems reported from Austria. Development of resistance to carbapenems in Enterobacteriaceae organisms has been reported increasingly, which substantially limits treatment options for persons with multidrug-resistant gram-negative infections (8). Our data show insignifi cant changes in prevalence of MRSA and vancomycin-resistant enterococci in southeast Austria during the past decade but an alarming increase of multidrug-resistant ESBL-producing E. coli and Klebsiella spp. isolates in recent years. Detection of an ESBLproducing K. pneumoniae isolate with reduced susceptibility to carbapenems shows that pathogens with new mechanisms of resistance are emerging in this region. Alexandra Badura,* Gebhard Feierl,* Harald H. Kessler,* Andrea Grisold,* Lilian Masoud,* Ute Wagner-Eibel,* and Egon Marth* *Medical University of Graz, Graz, Austria