Clinical and Molecular Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Klebsiella spp.: A Systematic Review and Meta-Analyses

Abstract

Healthcare-related infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella spp. are of major concern. To control transmission, deep understanding of the transmission mechanisms is needed. This systematic review aimed to identify risk factors and sources, clonal relatedness using molecular techniques, and the most effective control strategies for ESBL-producing Klebsiella spp. A systematic search of PubMed, Embase, and Outbreak Database was performed. We identified 2771 articles from November 25th, 1960 until April 7th, 2014 of which 148 were included in the systematic review and 23 in a random-effects meta-analysis study. The random-effects meta-analyses showed that underlying disease or condition (odds ratio [OR] = 6.25; 95% confidence interval [CI] = 2.85 to 13.66) generated the highest pooled estimate. ESBL-producing Klebsiella spp. were spread through person-to-person contact and via sources in the environment; we identified both monoclonal and polyclonal presence. Multi-faceted interventions are needed to prevent transmission of ESBL-producing Klebsiella spp.

Multidrug-resistant Gram-negative bacteria-resistant infections: epidemiology, clinical issues and therapeutic options

“…b-lactamases are hydrolytic enzymes able to disrupt the b-lactam ring, thus inactivating different classes of b-lactams. 3,4 The most common enzymes in clinical practice are the extended-spectrum-b-lactamases (ESBLs), which are mostly expressed by Enterobacteriaceae. A novel type of class C b-lactamases also showing activity against cefepime and denominated extended spectrum AmpC b-lactamases has been described.…”

“…7 Table 1 summarizes the classification of b-lactamases. 3 Together with the production of b-lactamases, additional mechanisms of carbapenem-resistance are the down-regulation of porins and efflux pumps, the last most common in P. aeruginosa and the expression of additional genes harbouring resistance to other antimicrobial classes, such as fluoroquinolones and aminoglycosides, thus narrowing the spectrum of therapeutic options. 8 …”

Successful control of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae ST307 outbreak in a neonatal intensive care unit

“…Extendedspectrum beta-lactamase (ESBL) is an enzyme involved in the hydrolysis of third-generation cephalosporins as well as aztreonam. ESBL-producing KPN (ESBL-KPN) spreads by person-to-person contact or via environmental sources [4,5]. Based on a systemic review of studies of ESBL-KPN outbreaks, the primary reservoirs of these pathogens include patients (48.9%), health-care workers (HCWs) (25.5%), and contaminated sinks (13.8%) [4].…”

Long-lasting outbreak due to CTX-M-15-producing Klebsiella pneumoniae ST336 in a rehabilitation ward: report and literature review

“…Klebsiella species are the most common agents in nosocomial outbreaks due to multidrugresistant Gram-negative bacteria [1]. Klebsiella species may reside in the bowel, nose, and trachea and on the skin, and are readily transmitted between patients [2][3][4][5].…”

“…Contamination of gloves and gowns occurs in 14% of healthcare worker (HCW)-patient interactions [6] and the organisms survive for more than two hours on hands [7]. In the environment, Klebsiella species have been detected from sources such as sinks, room surfaces, door handles, thermometers and liquid soap [1]. While the majority of nosocomial outbreaks due to ESBLproducing Klebsiella pneumoniae (ESBL-K. pneumoniae) occur in intensive care units [1], very few have been reported from rehabilitation wards, despite prevalent risk factors for transmission such as length of stay, urinary catheter use and high degree of dependency [1,8].…”