A 5-year epidemiological study of extended-spectrum betabeta-lactamase-producing Klebsiella pneumoniae isolates in a medium- and long-stay neurological unit

Abstract

Thirty‐eight different strains of extended‐spectrum β‐lactamase (ESBL)‐producing Klebsiella pneumoniae (ESBL Kp), isolated from urine and pus samples of 38 patients hospitalized in a medium‐ and long‐stay neurology department between 1 January 1992 and 31 December 1996, were analysed by antibiotic resistance phenotyping, DNA macrorestriction by pulsed‐field electrophoresis and isoelectric focusing of β‐lactamases. An epidemiological survey was conducted to identify risk factors for infection by ESBL Kp in this setting. The 38 isolates were distributed into 13 antibiotypes, three of which predominated (13, six and six isolates). The DNA macrorestriction pattern identified 15 genotypes, four of which predominated (11, six, four and four isolates). A combination of the two typing methods revealed several epidemic clones that emerged consecutively. Two main types of ESBL (SHV‐2 and CTX‐1) were identified by isoelectric focusing, the former predominating. The case‐control study showed that the length of hospital stay, degree of malnutrition and dependency, and urinary sphincter status were the main factors significantly associated with ESBL Kp isolation.

Extended-spectrum beta-lactamases in Klebsiella spp and Escherichia coli obtained in a Brazilian teaching hospital: detection, prevalence and molecular typing

“…This diversity in genotype was also described in Taiwan by Liu et al (30) who suggested that the increase of ESBL K. pneumoniae in their hospital was mainly due to dissemination, or mutation, in plasmids containing resistant genes. Conversely, in other centers the increase of ESBL K. pneumoniae was correlated with a single, or few, clones (17,30).…”

Extended-Spectrum β-Lactamases: a Clinical Update

“…Pulsed-field gel electrophoresis of chromosomal DNA is probably the most widely used method of genotyping ESBL-producing organisms (15,17,57,68,85,113,128,132,149,207,218,222,234,235,256,268,298,328,334,341,348,351,358,374,381,408,426,431,439). These references describe the restriction enzymes used for various organisms harboring ESBLs.…”

“…Numerous studies have used a case-control design with which to assess risk factors for colonization and infection with ESBL-producing organisms (16,19,40,96,103,205,222,234,291,299,311,358,419). Analysis of the results of these studies yelds a plethora of conflicting results, likely due to the differences in study populations, selection of cases, selection of controls, and sample size (286).…”

“…The median length of hospital stay prior to isolation of an ESBL producer has ranged from 11 to 67 days, depending on the study (19,40,96,103,104,205,419). In addition to those already mentioned, a myriad of other risk factors have been found in individual studies, including the presence of nasogastric tubes (19), gastrostomy or jejunostomy tubes (358,419) and arterial lines (222,299), administration of total parenteral nutrition (299), recent surgery (106), hemodialysis (96), decubitus ulcers (419), and poor nutritional status (234).…”

The Changing Epidemiology of Extended Spectrum Beta-Lactamases (ESBL) Infections of the Urinary Tract Focusing on Clinical Resistance and Therapeutic Options

“…However, the results are conflicting due to study populations, geographical areas, selection of cases and controls and sample size. (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48). Despite these statistical differences, some generalizations can be made.…”