Epidemiology and molecular characterization of nosocomially transmitted multidrug-resistant Klebsiella pneumoniae

Parasakthi, N; Vadivelu, Jamuna; Ariffin, Hany; Iyer, L.; Palasubramaniam, Selvi; Arasu, Anusha

doi:10.1016/s1201-9712(00)90072-9

Cited by 27 publications

(33 citation statements)

References 26 publications

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“…This is not surprising as K. pneumoniae is the most commonly reported ESBL producer worldwide and is a common cause of bloodstream infections, due in part to the facts that this species may be part of the normal bacterial flora, it can survive for a long period of time in the skin and fomites, and plasmids that confer antibiotic resistance are easily transferred to this species [26,27]. …”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Nosocomial Bloodstream Infections in a Tertiary Care Hospital: A Clinical and Molecular Analysis

et al. 2012

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Aim: To describe the risk factors and molecular epidemiology of nosocomial bloodstream infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in a tertiary care hospital. Methods: Patients with enterobacteria-positive blood cultures were included. ESBL expression in the isolates was detected using the combination disk method. Antimicrobial susceptibility testing was performed using the disk diffusion method. blaSHV, blaTEM, and blaCTX-M genes were identified in the isolated strains by PCR and sequencing. Klebsiella pneumoniae isolates were genotyped by PFGE. Results: Of the 90 isolates recovered, half were found to express ESBLs. Twenty-eight (62%) of these isolates were K. pneumoniae, 8 (18%) were Escherichia coli, 6 (13%) were Enterobacter cloacae, and 3 (7%) were Serratia marcescens. Multivariate logistic regression analysis showed that the only independent risk factor associated with infection by ESBL-producing strains was use of broad-spectrum cephalosporins. None of the isolates was resistant to imipenem. The blaSHV5 gene was detected in 84% of isolates, followed by blaCTX-M15 (27%), blaSHV2 (9%), and blaSHV12 (7%). PFGE identified six clones among the 28 ESBL-producing K. pneumoniae isolates. Conclusions: ESBL-producing K. pneumoniae clones were detected throughout the hospital. Use of broad-spectrum cephalosporins is the most important risk factor associated with the proliferation of ESBL-producing strains.

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Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Nosocomial Bloodstream Infections in a Tertiary Care Hospital: A Clinical and Molecular Analysis

et al. 2012

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“…These results suggest that the two organisms may interact with human skin in qualitatively different ways. Both organisms have been reported to contaminate soaps and lead to infections in health care settings (5,18,20,22). Even a brief contact (10 s) with contaminated soap resulted in detectable levels of bacteria on hands (Table 2).…”

Section: Vol 77 2011 Hand Contamination and Bulk-soap-refillable DImentioning

confidence: 99%

“…However, liquid soap can become contaminated with bacteria and poses a recognized health risk in health care settings. In particular, bulk-soap-refillable dispensers (ones in which new soap is poured into a dispenser) are prone to bacterial contamination, and several outbreaks linked to the use of contaminated soap in health care settings have been reported (2,3,5,15,18,(22)(23)(24). The Centers for Disease Control and Prevention (CDC) "Guideline for Hand Hygiene in Health-Care Settings" addresses this risk in a recommendation: "Do not add soap to a partially empty soap dispenser.…”

mentioning

confidence: 99%

Bacterial Hand Contamination and Transfer after Use of Contaminated Bulk-Soap-Refillable Dispensers

Zapka

Campbell

Maxwell

et al. 2011

Appl Environ Microbiol

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Bulk-soap-refillable dispensers are prone to extrinsic bacterial contamination, and recent studies demonstrated that approximately one in four dispensers in public restrooms are contaminated. The purpose of this study was to quantify bacterial hand contamination and transfer after use of contaminated soap under controlled laboratory and in-use conditions in a community setting. Under laboratory conditions using liquid soap experimentally contaminated with 7.51 log 10 CFU/ml of Serratia marcescens, an average of 5.28 log 10 CFU remained on each hand after washing, and 2.23 log 10 CFU was transferred to an agar surface. In an elementary-school-based field study, Gram-negative bacteria on the hands of students and staff increased by 1.42 log 10 CFU per hand (26-fold) after washing with soap from contaminated bulk-soap-refillable dispensers. In contrast, washing with soap from dispensers with sealed refills significantly reduced bacteria on hands by 0.30 log 10 CFU per hand (2-fold). Additionally, the mean number of Gram-negative bacteria transferred to surfaces after washing with soap from dispensers with sealed-soap refills (0.06 log 10 CFU) was significantly lower than the mean number after washing with contaminated bulk-soap-refillable dispensers (0.74 log 10 CFU; P < 0.01). Finally, significantly higher levels of Gram-negative bacteria were recovered from students (2.82 log 10 CFU per hand) than were recovered from staff (2.22 log 10 CFU per hand) after washing with contaminated bulk soap (P < 0.01). These results demonstrate that washing with contaminated soap from bulk-soaprefillable dispensers can increase the number of opportunistic pathogens on the hands and may play a role in the transmission of bacteria in public settings.

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“…2 However, during a four-week period between December 1997 and January 1998, the first documented outbreak of ESBL-producing K. pneumoniae occurred in the 28-bed paediatric oncology unit of the hospital and has been previously described. 3 The index case was a sevenyear-old boy from whom multidrug-resistant Klebsiella pneumoniae (MRKP) was isolated from blood culture and rectal swab. Following his admission to the ward, four other patients developed phenotypically similar MRKP septicaemia.…”

mentioning

confidence: 99%

SHV-5 extended-spectrum beta-lactamase from Klebsiella pneumoniae associated with a nosocomial outbreak in a paediatric oncology unit in Malaysia

Palasubramaniam

Subramaniam

Muniandy

et al. 2005

International Journal of Infectious Diseases

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Epidemiology and molecular characterization of nosocomially transmitted multidrug-resistant Klebsiella pneumoniae

Abstract: The MRKP strains in this outbreak were not clonal in origin. The decline of the outbreak after 4 weeks was attributed to the reemphasis of standard infection control procedures and the implementation of a program that addressed sites of environmental contamination.

Cited by 27 publications

References 26 publications

Risk Factors Associated with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Nosocomial Bloodstream Infections in a Tertiary Care Hospital: A Clinical and Molecular Analysis

Risk Factors Associated with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Nosocomial Bloodstream Infections in a Tertiary Care Hospital: A Clinical and Molecular Analysis

Bacterial Hand Contamination and Transfer after Use of Contaminated Bulk-Soap-Refillable Dispensers

SHV-5 extended-spectrum beta-lactamase from Klebsiella pneumoniae associated with a nosocomial outbreak in a paediatric oncology unit in Malaysia

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