{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T14:14:18Z","timestamp":1791123258059,"version":"4.1.0"},"reference-count":17,"publisher":"Microbiology Society","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2010,1,1]]},"abstract":"<jats:p>The aim was to study the clinical and microbiological features associated with a carbapenem-resistant <jats:italic>Klebsiella pneumoniae<\/jats:italic> isolate that had been selected <jats:italic>in vivo<\/jats:italic> by an ertapenem-containing regimen in a patient with mediastinitis despite high blood and mediastinal levels of ertapenem. Carbapenem resistance was characterized by conjugation, PCR, DNA sequencing and analysis of outer-membrane proteins. The isolates susceptible and resistant to the carbapenems were compared by ribotyping and PFGE. Resistance to all available <jats:italic>\u03b2<\/jats:italic>-lactams was most probably due to combined production of extended-spectrum <jats:italic>\u03b2<\/jats:italic>-lactamase (ESBL) CTX-M-15 and loss of OmpK36 porin. The results of ribotyping and PFGE suggest that the carbapenem-resistant strain was a derivative of the original mediastinal isolate rather than a superinfecting isolate. This observation stresses the risk of selection of pan-penem resistant strains of enterobacteria when ertapenem is used for the treatment of severe infections due to ESBL-producing enterobacteria.<\/jats:p>","DOI":"10.1099\/jmm.0.012468-0","type":"journal-article","created":{"date-parts":[[2009,11,3]],"date-time":"2009-11-03T22:57:02Z","timestamp":1257289022000},"page":"115-119","source":"Crossref","is-referenced-by-count":30,"title":["Development of ertapenem resistance in a patient with mediastinitis caused by Klebsiella pneumoniae producing an extended-spectrum \u03b2-lactamase"],"prefix":"10.1099","volume":"59","author":[{"given":"David","family":"Skurnik","sequence":"first","affiliation":[{"name":"Laboratoire de Bact\u00e9riologie, H\u00f4pital Bichat-Claude Bernard APHP, Universit\u00e9 Paris VII, 46 rue Henri Huchard, 75877 Paris Cedex 18, 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