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

Abstract

An outbreak due to extended-spectrum β-lactamase-producingKlebsiella 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).

Gastrointestinal colonization with ESBL-producing Klebsiella in preterm babies—is vancomycin to blame?

“…The role of the intestinal reservoir as an endogenous source of gramnegative infections in ICU and NICU patients has been described by other investigators [11][12][13][14].…”

“…In ICUs, there is a combination of wide use of empiric broad-spectrum antibiotics and high-risk patients with low levels of resistance to colonization [11]. The role of the intestinal reservoir as an endogenous source of gramnegative infections in ICU and NICU patients has been described by other investigators [11][12][13][14].…”

Changes of antimicrobial resistance and extended-spectrum β-lactamase production in Klebsiella spp. strains

“…23 The selective pressure created by the use of third-generation cephalosporins has been described as one of the most important factors in the appearance of these strains. 24,25 The present study also demonstrates an association between cephalosporin usage and the occurrence of ESBLproducing strains in the CMH. We believe that antibiotic restriction and better infection control could play complementary roles in preventing both the selection and spread of resistant bacterial pathogens, as already documented by Gruson and colleagues.…”

Molecular Epidemiology of Extended-Spectrum β-Lactamases from Klebsiella pneumoniae Strains Isolated in Zagreb, Croatia

“…Flanking measures, such as containment, hygiene, prudent and rational antibiotic use, and further epidemiological studies, are indicated. Finally, it is recommended that procedures reported to be successful for counteracting ESBLs [13][14][15] be implemented.…”