Nosocomial colonization with Klebsiella, type 26, in a neonatal intensive-care unit associated with an outbreak of sepsis, meningitis, and necrotizing enterocolitis

Hill, Harry R.; Hunt, Carl E.; Matsen, John M.

doi:10.1016/s0022-3476(74)80133-2

Cited by 141 publications

(53 citation statements)

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“…1970;Lancet, 1971), and multiply antibiotic resistant strains of K. aerogenes have caused serious outbreaks of infection which have often been extremely difficult to control (Price & Sleigh, 1970;Hable et al 1972;Hill, Hunt & Matsen, 1974;Curie et al 1978).…”

Section: Introductionmentioning

confidence: 99%

The development and assessment of a bacteriocin typing method forKlebsiella

Edmondson

Cooke

1979

J. Hyg.

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SUMMARYKlebsiellas are generally typed by the method of capsular serotyping but, although this is a reliable method, it is time consuming, requires the production of a large number of antisera and is not generally available. For this reason another method for typing klebsiellas was sought.A bacteriocin typing method involving mitomycin C induction was developed and the cultural conditions giving optimum klebecin production and the best methods of testing the sensitivity of the organisms to klebecins were determined.Of 190 klebsiella strains screened for bacteriocinogeny, only 68 (35.8 %) produced klebecin and after calculation of similarity values by computer analysis, a typing set of 15 producers was selected. This typing set allowed over 96 % of klebsiella strains to be typed and tests of the reproducibility of the method and the variability of typing patterns in natural populations of klebsiella indicated that results of acceptable accuracy could be obtained, while retaining good discrimination if two or more differences were required between patterns before they were regarded as distinct.A complete set of capsular antisera were prepared, enabling the results obtained from klebecin typing to be compared with those from serotyping. There was generally close agreement between the results from the two typing methods and greater discrimination was obtained between similar strains when the two methods were combined. Klebecin typing and serotyping revealed relationships between strains from five outbreaks of infection, and strains of the same serotype from different hospitals could frequently be distinguished by their klebecin typing patterns.

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Section: Introductionmentioning

confidence: 99%

The development and assessment of a bacteriocin typing method forKlebsiella

Edmondson

Cooke

1979

J. Hyg.

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“…Bettelheim and co-workers (1974, a, b and c) showed that although most babies were colonised by strains of Escherichia coli that were present in their own mother's faecal flora, some strains spread within the ward and were found in several babies. Noy, Ayliffe and Linton (1974) examined the acquisition of antibiotic-resistant gram-negative bacilli by neonates and also found that cross infection occurred with E. coli and with Klebsiella spp.Klebsiella aerogenes is becoming of increasing importance in hospital infection (Curie et al, 1978) and outbreaks of infection in neonates, associated with intestinal colonisation, have been reported (Adler et al, 1970;Kayyali, Nicholson and Smith, 1972;Hill, Hunt and Matsen, 1974). We describe here a study in which serotyping and klebecin typing were used and which was aimed at tracing the sources of K. aerogenes acquired by neonates in hospital.…”

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confidence: 99%

“…Klebsiella aerogenes is becoming of increasing importance in hospital infection (Curie et al, 1978) and outbreaks of infection in neonates, associated with intestinal colonisation, have been reported (Adler et al, 1970;Kayyali, Nicholson and Smith, 1972;Hill, Hunt and Matsen, 1974). We describe here a study in which serotyping and klebecin typing were used and which was aimed at tracing the sources of K. aerogenes acquired by neonates in hospital.…”

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Acquisition of Klebsiella Aerogenes by Neonates

Shinebaum

1979

Journal of Medical Microbiology

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THE sources of organisms causing many common infections and the transmission of enteropathogens may be studied by considering the organisms carried in the bowel of neonates. Bettelheim and co-workers (1974, a, b and c) showed that although most babies were colonised by strains of Escherichia coli that were present in their own mother's faecal flora, some strains spread within the ward and were found in several babies. Noy, Ayliffe and Linton (1974) examined the acquisition of antibiotic-resistant gram-negative bacilli by neonates and also found that cross infection occurred with E. coli and with Klebsiella spp.Klebsiella aerogenes is becoming of increasing importance in hospital infection (Curie et al., 1978) and outbreaks of infection in neonates, associated with intestinal colonisation, have been reported (Adler et al., 1970;Kayyali, Nicholson and Smith, 1972;Hill, Hunt and Matsen, 1974). We describe here a study in which serotyping and klebecin typing were used and which was aimed at tracing the sources of K. aerogenes acquired by neonates in hospital. MATERIALS AND METHODSSources of samples. Faeces were obtained at 2 and 6 days of age from babies born in the Leeds Maternity Hospital and from mothers before delivery, generally during the first stage of labour.Other samples were taken from milk feeds, disinfectants, medicaments, surfaces, baths, sinks, soaps, creams, the hands and uniforms of nursing staff, and the hands of mothers. Settle plates were exposed on the ward for periods of 24 h.Sampling methods. Surfaces, baths, sinks, and creams were sampled with swabs ; liquids were passed through a membrane filter. Hands were agitated in 250 ml of quarter-strength Ringer's solution which was examined as other liquids. Uniforms were sampled by impression on solid culture media.Bacteriology. Faeces and swabs were examined as previously (Cooke et al., 1979). Membrane filters were incubated on blood agar, and impression plates and settle plates were of this medium. Except in the fmt survey, 10 colonies were taken from each sample and identified, serotyped and klebecin-typed as before . Survey I . Faecal samples from babies on one ward were examined, 84 babies being 2 days old and 100 babies 6 days old.Survey 2. Faecal samples were examined from 49 pairs of mothers and babies.Srrrwey 3. Faecal samples were examined from all the babies on one ward three times a week, and from the environment twice a week for 10 weeks.

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“…Despite antibiotic therapy, drug-resistant K. pneumoniae strains can colonize the intestines and nasopharynx (2, 8,24,26) and invade tissues and blood, causing lethal or potentially lethal infections (13,17,21,25). We report here the characteristics of nine strains of K. pneumoniae isolated from an outbreak ofinfection and compare the properties of these strains with those of other strains previously studied (23) Antibiotic susceptibility testing and transfer ofresistance.…”

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confidence: 97%

“…The broadening of resistance was accompanied by reduced uptake of radioactively labeled streptomycin and gentamicin. The relationship between aminoglycoside resistance and reduced drug transport in the absence of any enzymatic modification is discussed.The occurrence of drug-resistant Klebsiella pneumoniae as a cause of life-threatening disease in intensive care nurseries (1,10,16,17,23) remains a challenge in the management of this type ofselected patient population. Despite antibiotic therapy, drug-resistant K. pneumoniae strains can colonize the intestines and nasopharynx (2,8,24,26) and invade tissues and blood, causing lethal or potentially lethal infections (13,17,21,25).…”

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Klebsiella neonatal injections: mechanism of broadening aminoglycoside resistance

Hardy¹,

Legeai²,

O’Callaghan³

1980

Antimicrob Agents Chemother

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Kanamycin resistance in eight strains of Klebsiellapneumoniae isolated during an outbreak of infection in a neonatal intensive care unit was found to be transferable and mediated by neomycin phosphotransferase. After gentamicin was used to control infections caused by kanamycin-resistant organisms, a strain resistant to gentamicin emerged. Gentamicin resistance in this ninth strain was not transferable and was accompanied by resistance to tobramycin, amikacin, and streptomycin. Enzymatic modifications of aminoglycosides other than neomycin and kanamycin could not be demonstrated either by filter binding assays or by electrophoresis of a radioactive aminoglycoside substrate. The strain with broad aminoglycoside resistance contained six plasmid deoxyribonucleic acid bands, none of which appeared to be different in molecular weight from plasmid deoxyribonucleic acid bands in strains isolated before the institution of gentamicin therapy. The broadening of resistance was accompanied by reduced uptake of radioactively labeled streptomycin and gentamicin. The relationship between aminoglycoside resistance and reduced drug transport in the absence of any enzymatic modification is discussed.The occurrence of drug-resistant Klebsiella pneumoniae as a cause of life-threatening disease in intensive care nurseries (1,10,16,17,23) remains a challenge in the management of this type ofselected patient population. Despite antibiotic therapy, drug-resistant K. pneumoniae strains can colonize the intestines and nasopharynx (2,8,24,26) and invade tissues and blood, causing lethal or potentially lethal infections (13,17,21,25). We report here the characteristics of nine strains of K. pneumoniae isolated from an outbreak ofinfection and compare the properties of these strains with those of other strains previously studied (23) in connection with neonatal infections. MATERIALS AND METHODSIsolation of strains. Strains of K pneumoniae were obtained from stool and blood specimens submitted to the clinical bacteriology laboratory at Confederate Memorial Medical Center, Shreveport, La., and were kindly referred to us by Ronald Silberman, Director of Microbiology. The biotype of each isolate was confirmed in our laboratory, and the serotype was determined at the Center for Disease Control, Atlanta, Ga.Antibiotic susceptibility testing and transfer ofresistance. The susceptibilities ofeach isolate were determined by measuring the minimal inhibitory concentrations (MICs) of antibiotics in tryptic soy broth (TSB) (Difco Laboratories, Detroit, Mich.) (23). The abilities of resistant strains to transfer specific resistance traits were determined by cocultivating isolates with a naladixic acid-resistant recipient strain of Escherichia coli, as previously described (23).Enzyme assays. Bacterial cell lysates were prepared by osmotic shock and/or sonication, as described by Haas and Dowding (15) for extraction of periplasmic contents. Aminoglycoside-modifying enzymes were assayed by the phosphocellulose paper binding method (15).

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Nosocomial colonization with Klebsiella, type 26, in a neonatal intensive-care unit associated with an outbreak of sepsis, meningitis, and necrotizing enterocolitis

Cited by 141 publications

References 11 publications

The development and assessment of a bacteriocin typing method forKlebsiella

The development and assessment of a bacteriocin typing method forKlebsiella

Acquisition of Klebsiella Aerogenes by Neonates

Klebsiella neonatal injections: mechanism of broadening aminoglycoside resistance

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