Hospital-acquired Klebsiella bacteremia

Terman, James W.; Alford, Robert H.; Bryant, Richard E.

doi:10.1097/00000441-197209000-00004

Cited by 18 publications

(4 citation statements)

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“…Other factors have not been correlated with this observation; however, several authors have reported that the use of antibiotics may select for Gram-negative bacilli which are often infectious (Selden et al, 1971;Finland, 1972;Terman et al, 1972;Schimpff et al, 1974;Marples, 1975).…”

Section: Discussionmentioning

confidence: 89%

Epidemiological study of klebsiella infection in the special care baby unit of a London hospital

1980

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Section: Discussionmentioning

confidence: 89%

Epidemiological study of klebsiella infection in the special care baby unit of a London hospital

1980

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“…Interestingly, early reports of Kiebsiella bacteremia reported a nosocomial predominance (11,13); however, in recent years a greater percentage of community-acquired cases have been reported (6, 7) ( Table 5). In our study, the incidences of community-acquired bacteremias were 60, 46, and 38% in community hospitals, university hospitals, and VA medical centers, respectively; this difference was statistically significant.…”

Section: Discussionmentioning

confidence: 98%

Prospective observational study of Klebsiella bacteremia in 230 patients: outcome for antibiotic combinations versus monotherapy

Korvick

Bryan

Farber

et al. 1992

Antimicrob Agents Chemother

196

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Combination antimicrobial agent therapy has been advocated for treatment of gram-negative bacteremia, including that caused by KlebsielUa spp. We performed a prospective, observational, 10-hospital collaborative study to evaluate the efficacy of antibiotic combination therapy versus that of monotherapy for 230 consecutive patients with KiebsieUla bacteremia. The species involved were K. pneumoniae (82%), K. oxytoca (15%), and K. ozaenae (0.4%). Of the bacteremias, 26% were polymicrobial in nature. A total of 53% of cases were nosocomial infections. The most common portals were the urinary tract (28%), biliary tract (12%), lung (10%b), and abdomen (9%k). Some 49 and 51% of the patients had received monotherapy and antibiotic combination therapy (beta-lactam plus aminoglycoside), respectively; 14-day mortalities in the two groups were 20 and 18%, respectively. However, for the subgroup of patients who experienced hypotension within 72 h prior to or on the day of the positive blood culture, those patients who received combination therapy experienced significantly lower mortality (24%) than did those who received monotherapy (50%k). We conclude that monotherapy with an antibiotic that is active in vitro against KiebsieUla (beta-lactam or aminoglycoside) is sufficient therapy for less severely ill patients (immunocompetent, urinary tract portal, mentally alert, normal vital signs). On the other hand, for severel ill patients who experience hypotension, antibiotic combination therapy with a beta-lactam and an aminoglycoside agent is preferred.Klebsiella spp. are the second most frequent cause of gram-negative bacteremia (3,5,12,14). Combination therapy with a beta-lactam and an aminoglycoside has been advocated for treatment of Klebsiella bacteremia because of its notable mortality (1,11,15).Most studies of bacteremia have focused on Klebsiella spp. not as a single entity but, rather, have included it in the category of gram-negative bacteremias. This is problematic, given the inherent differences in antibiotic susceptibility and virulence among the aerobic gram-negative rods. Young (15) has also pointed out that failure to stratify patients by underlying disease category in most studies of therapy for gram-negative bacteremia has resulted in invalid comparisons of antibiotic efficacy.We performed a prospective, observational, multicenter collaborative study to evaluate the efficacy of antibiotic combination therapy versus monotherapy on the outcome of Klebsiella infections. We made a concerted effort to address those areas of weakness that have characterized previous studies, including a prospective rather than retrospective study design, adequate sample size for statistical evaluation, assessment for severity of illness, and requirement for bacteremia as an eligibility criterion. Furthermore, given the large sample size of 230 patients, analysis by subgroups including underlying disease was feasible. MATERIALS AND METHODSStudy design. From 1986 to 1987, 230 consecutive patients from whose blood Klebsiella spp. were ...

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“…Multiply antibiotic-resistant bacteria complicate the clinical treatment of infections by reducing the number of potentially useful chemotherapeutic agents. This is a special problem in compromised hosts with limited abilities to combat infections (38,39). It has been documented that a large percentage of human clinical Klebsiella possess multiple antibiotic resistance and up to 80% of these resistant isolates possess transmissible R-plasmids (3,40).…”

Section: Discussionmentioning

confidence: 99%

“…Klebsiella is an opportunistic pathogen and is a causative agent of several kinds of infections in humans (10,16,35,37,38) and animals (8,14,20,26). In addition to its clinical role, Klebsiella has been found to occur at high cell densities in many botanical environments.…”

mentioning

confidence: 99%

Antibiotic Resistance and Its Transfer Among Clinical and Nonclinical Klebsiella Strains in Botanical Environments

Talbot

Yamamoto

Smith

et al. 1980

Appl Environ Microbiol

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A total of 183 isolates of Klebsiella from drinking water, market vegetables, wood, sawdust, industrial effluents, and human and animal origin were examined for susceptibility to 10 antibacterial agents. Incidence of resistance to two or more antibiotics tested was: 65% of the human clinical isolates, 59% among bovine mastitis, and 24% among the nonclinical isolates. The five different multiple resistance patterns among nonclinically derived Klebsiella were also found among the human and bovine mastitis isolates. Statistical analyses revealed that patterns of resistance among Klebsiella isolates from drinking water, market vegetables, and industrial effluents were highly correlated with each other and with resistance patterns of human clinical isolates. Antibiotic resistance was transferred between Klebsiella growing in two habitat-simulated environments (growing radish plants and aqueous sawdust suspensions). Transconjugants were detected in 5 of 21 and 6 of 21 mating pairs, respectively. Average transconjugants/donor ranged from

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Hospital-acquired Klebsiella bacteremia

Cited by 18 publications

References 0 publications

Epidemiological study of klebsiella infection in the special care baby unit of a London hospital

Epidemiological study of klebsiella infection in the special care baby unit of a London hospital

Prospective observational study of Klebsiella bacteremia in 230 patients: outcome for antibiotic combinations versus monotherapy

Antibiotic Resistance and Its Transfer Among Clinical and Nonclinical Klebsiella Strains in Botanical Environments

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