Epidemiology and Successful Control of a Large Outbreak Due to <i>Klebsiella pneumoniae</i> Producing ExtendedSpectrum β-Lactamases

Antimicrobial Agents and Chemotherapy - Tập 42 Số 1 - Trang 53-58 - 1998
Carmen Peña1, Miquel Pujol1, Carmen Ardanuy2, A. Ricart3, Román Pallarés1, Josefina Liñares2, Javier Ariza1, Francisco Gudiol1
1Infectious Disease Service,1
2Microbiology Service,2 and
3Intensive Care Unit Service,3 Hospital de Bellvitge, Universidad de Barcelona, Barcelona, Spain

Tóm tắt

ABSTRACT An outbreak due to extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) was detected from May 1993 to June 1995. A total of 145 patients, particularly patients in intensive care units (ICUs) (107 patients [72%]), were colonized or infected. Infection developed in 92 (63%) patients, and primary bacteremia caused by ESBL-KP was the most frequent infection (40 of 92 patients [43%]). A single clone of ESBL-KP was identified by pulsed-field gel electrophoresis analysis throughout the whole period, and no molecular epidemiological relationship could be found between the epidemic strain and non-ESBL-KP isolates. To determine risk factors for ESBL-KP infection weekly rectal swabs were obtained in three serial incidence surveys (470 patients); the probabilities of carriage of ESBL-KP in the digestive tract were 33% (October and November 1993), 40% (May and June 1994), and 0% (October and November 1995) at 10 days of ICU admission. A logistic regression model identified prior carriage of ESBL-KP in the digestive tract (odds ratio, 3.4; 95% confidence interval 1.1 to 10.4) as an independent variable associated with ESBL-KP infection. A statistically significant correlation was observed between the restricted use of oxyimino-β-lactams (189 defined daily doses [DDD]/1,000 patient-days to 24 DDD/1,000 patient-days) and the trends of ESBL-KP infection ( r = 0.7; P = 0.03).

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Tài liệu tham khảo

Arlet G. Sanson-Le Pors M. J. Rouveau M. Fournier G. Marie O. Schlemmer B. Philippon A. Outbreak of nosocomial infections due to Klebsiella pneumoniae producing SHV-4 β-lactamase. Eur. J. Clin. Microbiol. Infect. Dis. 9 1990 797 803

10.1128/jcm.32.10.2553-2558.1994

10.1128/AAC.31.5.723

Bauerfeind A. Rosenthal E. Eberlein E. Holley M. Schweighart S. Spread of Klebsiella pneumoniae producing SHV-5 β-lactamase among hospitalized patients. Infection 21 1993 18 22

10.2307/30141029

10.1016/S0140-6736(87)90891-9

10.7326/0003-4819-110-11-873

10.1128/iai.60.1.44-55.1992

10.1128/jcm.27.12.2887-2890.1989

10.1128/iai.64.6.2266-2273.1996

10.1128/jcm.33.3.713-717.1995

10.1016/0196-6553(88)90053-3

10.1017/S0195941700058264

10.1128/jcm.32.2.301-305.1994

Hibbert-Rogres L. C. F. Heritage J. Gascoyne-Binzi D. M. Hawkey P. M. Todd N. Lewis I. J. Bailey C. Molecular epidemiology of ceftazidime resistant Enterobacteriaceae from patients on a paediatric oncology ward. J. Antimicrob. Chemother. 36 1995 65 82

10.1128/AAC.35.9.1697

10.1093/clinids/10.4.867

10.1016/0195-6701(92)90111-X

Le Gall J. R. Loirat P. Alperovitch A. Glaser P. Granthil C. Mathieu D. Mercier P. Thomas R. Villers D. A simplified acute physiologic score for ICU patients. Crit. Care Med. 12 1984 975 977

Legrand P. Fournier G. Buré A. Jarlier V. Nicolas M. H. Decre D. Duval J. Philippon A. Detection of extended broad-spectrum beta-lactamases in Enterobacteriaceae in four french hospitals. Eur. J. Clin. Microbiol. Infect. Dis. 8 1989 527 529

Lucet J. C. Chevres S. Decré D. Vanjak D. Macrez A. Bédos J. P. Wolff M. Regnier B. Outbreak of multiply resistant Enterobacteriaceae in an intensive care unit: epidemiology and risk factors for acquisition. Clin. Infect. Dis. 22 1996 430 436

Martin C. M. N. S. Ikari J. Zimmerman and J. A. Naitz. 1971. A virulent nosocomial Klebsiella with a transferable R factor for gentamicin: emergence and suppression. J. Infect. Dis. 124 (Suppl.) : S24–S29.

McCabe W. R. Jackson G. G. Gram-negative bacteremia. II. Clinical, laboratory, and therapeutic observations. Arch. Intern. Med. 110 1962 856 864

10.1093/clinids/5.6.1033

McGowan J. E. Do intensive hospital antibiotic control programs prevent the spread of antibiotic resistance? Infect. Control Hosp. Epidemiol. 15 1994 478 483

Meyer K. S. Urban C. Eagan J. A. Berger B. J. Rahal J. J. Nosocomial outbreak of Klebsiella pneumoniae resistant to late-generation cephalosporins. Ann. Intern. Med. 119 1993 353 358

Montgomerie J. Z. Epidemiology of Klebsiella and hospital-associated infections. Rev. Infect. Dis. 5 1979 736 753

National Committee for Clinical Laboratory Standards Methods for dilution antimicrobial susceptibility test for bacteria that grow aerobically. Document M7-A4. 1997 National Committee for Clinical Laboratory Standards Villanova Pa

10.1128/AAC.36.9.1991

Nordic Council on Medicines Nordic statistics on medicines. Nordic drug index with classification and defined daily doses. 1994 Nordic Council on Medicines Uppsala Sweden

Peña C. Pujol M. Ricart A. Ardanuy C. Ayats J. Liñares J. Garrigosa F. Ariza J. Gudiol F. Risk-factors for fecal carriage of Klebsiella pneumoniae producing extended-spectrum β-lactamases in the intensive care unit. J. Hosp. Infect. 35 1997 9 16

10.1128/AAC.34.11.2193

10.1093/clinids/23.1.118

Sanders W. E. Jr. Sanders C. C. Cycling of antibiotics: an approach to circumvent resistance in specialized units of the hospital. Clin. Microbiol. Infect. 1 1996 223 225

10.7326/0003-4819-74-5-657

Sirot J. Chanal C. Petit A. Sirot D. Labia R. Gerbaud G. Klebsiella pneumoniae and other Enterobacteriaceae producing novel plasmid-mediated beta-lactamases markedly active against third-generation cephalosporins: epidemiologic studies. Rev. Infect. Dis. 10 1988 850 859

10.1017/S0022172400021653

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Antimicrobial Agents and Chemotherapy

Tập 42 Số 1

53-58

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