Klebsiella pneumoniae causes serious epidemic and endemic nosocomial infections. We conducted a literature review to characterize the epidemiology of epidemic K. pneumoniae outbreaks. Eighty percent of the outbreaks (20/25) involved infections of the bloodstream or urinary tract. Person-to-person spread was the most common mode of transmission, and nearly 50% of the outbreaks occurred in neonatal intensive care units. No one serotype predominated, and no association was found between serotype and either the site of infection or the antimicrobial susceptibility pattern.We used data reported to the Centers for Disease Control (CDC) by hospitals participating in the National Nosocomial Infections Study (NNIS) to describe the epidemiology of endemic K. pneumoniae infections. In die 8-year period from 1975 through 1982 the nosocomial K. pneumoniae infection rate was 16.7 infections per 10,000 patients discharged. The rate of infection at medical school-affiliated hospitals was significantly greater than at nonaffiliated hospitals; furthermore, the rate of infection at large affiliated hospitals was greater than at small affiliated hospitals. The rate of infection varied by service, with the highest rate found on the medicine service. During the 8-year period, 184 deaths were caused by nosocomial K. pneumoniae infections (184 deaths/16,969 infections, case-fatality ratio 1.1%), with higher ratios in pediatrics (5%) where there was a 12% mortality in children infected with an aminoglycoside-resistant strain.

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Abstract. Epidemiologic investigations of the Latin America cholera epidemic have repeatedly implicated untreated drinking water and water touched by hands during storage as important vehicles for disease transmission. To prevent such transmission, we provided a new narrow-mouthed, plastic, water storage vessel and 5% calcium hypochlorite solution for home disinfection of stored water to a Bolivian Aymara Indian community at risk for cholera. We evaluated acceptance of this intervention and its effect on water quality. Each of 42 families in the study obtained water from a household well; fecal coliform bacteria were found in water from 39 (93%) of 42 wells and 33 (79%) of 42 usual water storage vessels. One group of families received the special vessels and chlorine (group A), a second received only the special vessels (group B), and a third served as a control group (group C). Water samples collected every three weeks from group A special vessels had lower geometric mean fecal coliform colony counts (P < 0.0001) and lower geometric mean Escherichia coil colony counts (P < 0.0001) than water from group B or C vessels. Adequate levels of free chlorine persisted in these vessels for at least 5 hr. The special vessels and chlorine solution were well accepted and continued to be used for at least six months. Use of the vessel and chlorine solution produced drinking water from nonpotable sources that met World Health Organization standards for microbiologic quality.

Although outbreaks of waterborne disease are probably underrecognized and underreported, the reported data are helpful in identifying water treatment deficiencies as well as in characterizing the epidemiology of waterborne disease. For 1991 and 1992, 17 states and territories reported 34 outbreaks of disease associated with drinking water, which affected an estimated 17,464 people. A protozoal parasite (Giardia lamblia or Cryptosporidium) was identified as the etiologic agent for seven of the eleven outbreaks for which an agent was determined; the remaining four were due to hepatitis A, Shigella sonnei, or chemicals. A lack of treatment or inadequate treatment accounted for the majority of outbreaks, and most (76 percent) were associated with well water. In addition, eight states reported eleven outbreaks of gastroenteritis associated with unintentional ingestion of recreational water. Six of these outbreaks were caused by Giardia or Cryptosporidium. Ongoing for 22 years, this national surveillance of waterborne disease helps to identify deficiencies in water systems and the etiologic agents associated with outbreaks.

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