Evidence of Interhospital Transmission of Extended-Spectrum β-Lactam-Resistant <i>Klebsiella pneumoniae</i> in the United States, 1986 to 1993

Dl, Monnet; Jw, Biddle; Edwards,; Dh, Culver; Js, Tolson; Wj, Martone; Fc, Tenover; Rp, Gaynes

doi:10.1086/647654

Cited by 57 publications

(15 citation statements)

References 44 publications

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“…The outbreak was also fueled by hospital-to-hospital transfers, as shown by the very large number of health care institutions where ESBLPE-positive patients were transferred to or from. These data are in keeping with several reports [13,23,44]. A recent study examined the first SHV-4 extended-spectrum blactamase-producing K. pneumoniae strain isolated in 14 French hospitals, mainly in the Paris area [44].…”

Section: Discussionsupporting

confidence: 88%

“…In 1993, 9.4% of K. pneumoniae isolates in the National Nosocomial Infection System were ESBLPE [23]. The same year, the Paris Area Public Hospital Surveillance Network found that as many as 24.8% of K. pneumoniae isolates were ESBLPE, indicating an outbreak more extensive than any other reported worldwide [29].…”

Section: Discussionmentioning

confidence: 99%

“…Barrier precautions, screening tests for ICU patients, and grouping of cohorts after ICU discharge are effective in controlling the spread of multidrug-resistant microorganisms by cross-contamination. The outbreak was effectively controlled without restricting antimicrobial use.Since extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBLPE) were first recognized in 1983 [1], many outbreaks have been reported in France [2-9], other European countries [10][11][12][13][14][15][16], and North America [17][18][19][20][21][22][23]. These multidrug-resistant organisms have now spread worldwide [24][25][26][27].…”

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confidence: 99%

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Control of a Prolonged Outbreak of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in a University Hospital

Lucet

Decré²,

Fichelle

et al. 1999

Clinical Infectious Diseases

160

101

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Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE) were isolated from clinical specimens from 130 to 140 patients/year in 1989-1991 in our hospital. In February 1992, a control program was initiated: screening tests in 3 intensive care units (ICUs) and contact-isolation precautions in all units. The septic surgical unit served as an isolation ward for surgical patients from whom ESBLPE was isolated. In 1992, the incidence of ESBLPE acquisition failed to decrease, and most acquisitions occurred in 3 ICUs. Critical evaluation of implementation of isolation procedures in these ICUs prompted corrective measures for barrier precautions. The incidence of acquired cases subsequently decreased, and a second evaluation determined that these measures had been correctly applied. The incidence of acquired cases in the septic surgical unit was lower than those in the other units. Decreases were also found in the incidence of acquisition of other hand-transmitted multidrug-resistant organisms. Barrier precautions, screening tests for ICU patients, and grouping of cohorts after ICU discharge are effective in controlling the spread of multidrug-resistant microorganisms by cross-contamination. The outbreak was effectively controlled without restricting antimicrobial use.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Control of a Prolonged Outbreak of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in a University Hospital

Lucet

Decré²,

Fichelle

et al. 1999

Clinical Infectious Diseases

160

101

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“…However, clonal spread did not explain the overall prevalence of isolates expressing an ESBL in each hospital, since unrelated ESBL organisms were also identified. In addition, there was no clear evidence of significant clonal spread from hospital to hospital or country to country, although previous studies have identified more widespread transmission [26]. These data did identify distinct isolates expressing similar b-lactamases with more unusual pI values.…”

Section: Discussionmentioning

confidence: 58%

Variations in the Prevalence of Strains Expressing an Extended‐Spectrum β‐Lactamase Phenotype and Characterization of Isolates from Europe, the Americas, and the Western Pacific Region

Winokur

Cantón

Casellas³

et al. 2001

CLIN INFECT DIS

385

265

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To evaluate the prevalence of extended-spectrum beta-lactamase (ESBL)-producing strains among species of Enterobacteriaceae, a microdilution susceptibility test was performed with strains of Klebsiella pneumoniae, Escherichia coli, Proteus mirabilis, and Salmonella species that were isolated as part of the SENTRY project. The highest percentage of ESBL phenotype (defined as a minimum inhibitory concentration [MIC] > or =2 microg/mL for ceftazidime, ceftriaxone, or aztreonam) was detected among K. pneumoniae strains from Latin America (45%), followed by those from the Western Pacific region (25%), Europe (23%), the United States (8%), and Canada (5%). P. mirabilis and E. coli strains for which MICs of extended-spectrum cephalosporins or monobactams were elevated also were more prominent in Latin America. Testing with ceftazidime revealed more isolates with elevated MICs than did testing with ceftriaxone or aztreonam. ESBL strains showed high levels of co-resistance to aminoglycosides, tetracycline, trimethoprim-sulfamethoxazole, and ciprofloxacin. Imipenem remains highly effective against ESBL strains. Organisms expressing an ESBL are widely distributed worldwide, although prevalence rates are significantly higher in certain geographic regions.

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“…On a broader scale, identification of resistant clones with extensive geographic distribution may provide insight into strain virulence and pathogenesis and also may result in public health interventions such as vaccination and antimicrobial restrictions aimed at reducing the spread of the pathogen and the resistance problem [13,14,32,33].…”

Section: Application Of Molecular Methods In a Global Surveillance Symentioning

confidence: 99%

Integration of Molecular Characterization of Microorganisms in a Global Antimicrobial Resistance Surveillance Program

Pfaller¹,

Acar²,

Jones³

et al. 2001

CLIN INFECT DIS

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The SENTRY Antimicrobial Surveillance Program has incorporated molecular strain typing and resistance genotyping as a means of providing additional information that may be useful for understanding pathogenic microorganisms worldwide. Resistance phenotypes of interest include multidrug-resistant pathogens, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, and fluoroquinolone-resistant (FQR) strains of gram-negative bacilli and Streptococcus pneumoniae. Clusters of > or =2 isolates within a given resistance profile that are linked temporally and by hospital location are flagged for DNA fingerprinting. Further characterization of organisms with respect to resistance genotype is accomplished with use of polymerase chain reaction and DNA sequencing. This process has been highly successful in identifying clonal spread within clusters of multiresistant pathogens. Between 50% and 90% of MRSA clusters identified by phenotypic screening contained evidence of clonal spread. Among the Enterobacteriaceae, ESBL-producing strains of Escherichia coli and Klebsiella pneumoniae are the most common pathogens causing clusters of infection, and approximately 50% of recognized clusters demonstrate clonal spread. Clusters of Pseudomonas aeruginosa, Acinetobacter species, and Stenotrophomonas maltophilia have been noted with clonal spread among patients with urinary tract, respiratory, and bloodstream infections. Characterization of mutations in the FQR-determining region of phenotypically susceptible isolates of E. coli and S. pneumoniae has identified first-stage mutants among as many as 40% of isolates. The ability to characterize organisms phenotypically and genotypically is extremely powerful and provides unique information that is important in a global antimicrobial surveillance program.

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Evidence of Interhospital Transmission of Extended-Spectrum β-Lactam-Resistant Klebsiella pneumoniae in the United States, 1986 to 1993

Abstract: These data provide evidence of interhospital transmission of ESBLR K pneumoniae in one region of the United States and stress the interrelationship between hospitals when trying to control antimicrobial resistance.

Cited by 57 publications

References 44 publications

Control of a Prolonged Outbreak of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in a University Hospital

Control of a Prolonged Outbreak of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in a University Hospital

Variations in the Prevalence of Strains Expressing an Extended‐Spectrum β‐Lactamase Phenotype and Characterization of Isolates from Europe, the Americas, and the Western Pacific Region

Integration of Molecular Characterization of Microorganisms in a Global Antimicrobial Resistance Surveillance Program

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