Outbreak of OXY-2-Producing
            <i>Klebsiella oxytoca</i>
            in a Renal Transplant Unit

Zárate, Mariela Soledad; Gales, Ana Cristina; Picão, Renata C.; Pujol, Gervasio Soler; Lanza, Alejandra; Smayevsky, Jorgelina

doi:10.1128/jcm.00194-08

Cited by 26 publications

(20 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, there was no clustering or epidemiological link among the patients with K. oxytoca in our health care setting that would be suggestive of a nosocomial outbreak. This was supported by the multiclonality of our K. oxytoca isolates, as demonstrated by PFGE, as nosocomial outbreaks are usually caused by a single strain (32,39). The lack of evidence for the nosocomial transmission of K. oxytoca might be related to the mild disease in our population.…”

Section: Discussionsupporting

confidence: 61%

“…Health care-associated diarrhea was found for 44 (42%) of 104 patients with K. oxytoca, which should alert infection control professionals to the possibility of outbreaks. In fact, nosocomial outbreaks due to K. oxytoca were reported previously (32,39), including a report of the detection of a multidrug-resistant strain (13), which warranted proactive infection control measures. However, unlike the situation with C. difficile and methicillin-resistant Staphylococcus aureus, where the major reservoir is patients from nursing homes, who act as silent carriers in nosocomial outbreaks (9,12), none of our patients with health care-associated diarrhea due to K. oxytoca were admitted from nursing homes.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology of Klebsiella oxytoca-Associated Diarrhea Detected by Simmons Citrate Agar Supplemented with Inositol, Tryptophan, and Bile Salts

et al. 2012

View full text Add to dashboard Cite

We studied the clinical and epidemiological characteristics of Klebsiella oxytoca-associated diarrhea in hospitalized patients in Hong Kong. Between 1 November 2009 and 30 April 2011, all inositol-fermenting colonies found on Simmons citrate agar supplemented with inositol, tryptophan, and bile salts (SCITB agar) used for the culturing of diarrheal stool samples were screened by a spot indole test for K. oxytoca. The overall sensitivity of SCITB agar plus the spot indole test (93.3%) for the detection of K. oxytoca in stool samples was superior to that of MacConkey agar (63.3%), while the specificities were 100% and 60.4%, respectively. The former achieved a 23-fold reduction in the workload and cost of subsequent standard biochemical identifications. Cytotoxin production and the clonality of K. oxytoca were determined by a cell culture cytotoxicity neutralization assay using HEp-2 cells and pulsed-field gel electrophoresis (PFGE), respectively. Of 5,581 stool samples from 3,537 patients, K. oxytoca was cultured from 117/5,581 (2.1%) stool samples from 104/3,537 (2.9%) patients. Seventy-six of 104 (73.1%) patients with K. oxytoca had no copathogens in their diarrheal stool samples. Twenty-four (31.6%) of 76 patients carried cytotoxin-producing strains, which were significantly associated with antibiotic therapy after hospital admission (50% versus 21.2%; P ‫؍‬ 0.01). Health care-associated diarrhea was found in 44 (42%) of 104 patients with K. oxytoca, but there was no epidemiological linkage suggestive of a nosocomial outbreak, and PFGE showed a diverse pattern. None of the patients with cytotoxin-producing K. oxytoca developed antibiotic-associated hemorrhagic colitis, suggesting that K. oxytoca can cause a mild disease manifesting as uncomplicated antibiotic-associated diarrhea with winter seasonality.

show abstract

Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Epidemiology of Klebsiella oxytoca-Associated Diarrhea Detected by Simmons Citrate Agar Supplemented with Inositol, Tryptophan, and Bile Salts

et al. 2012

View full text Add to dashboard Cite

show abstract

“…As K. oxytoca isolates were detected over a 2-year period, a reservoir in the environment was suspected. Nosocomial outbreaks with K. oxytoca have been reported previously (4)(5)(6)(7)(8)(9)(10). In two publications, handwashing sinks, especially sink drains, were identified as the source of the outbreaks (9,10).…”

mentioning

confidence: 94%

Contaminated Handwashing Sinks as the Source of a Clonal Outbreak of KPC-2-Producing Klebsiella oxytoca on a Hematology Ward

Leitner

Zarfel

Luxner

et al. 2015

Antimicrob Agents Chemother

119

View full text Add to dashboard Cite

We investigated sinks as possible sources of a prolonged Klebsiella pneumonia carbapenemase (KPC)-producing Klebsiella oxytoca outbreak. Seven carbapenem-resistant K. oxytoca isolates were identified in sink drains in 4 patient rooms and in the medication room. Investigations for resistance genes and genetic relatedness of patient and environmental isolates revealed that all the isolates harbored the bla KPC-2 and bla TEM-1 genes and were genetically indistinguishable. We describe here a clonal outbreak caused by KPC-2-producing K. oxytoca, and handwashing sinks were a possible reservoir.

show abstract

“…Klebsiella oxytoca and Klebsiella pneumoniae are frequent sources of nosocomial infections and the sources of nosocomial outbreaks [1,2]. The occurrence of multidrug resistance is increasingly observed among the Gram-negative pathogens Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae.…”

Section: Introductionmentioning

confidence: 99%

Modulation of mgrB gene expression as a source of colistin resistance in Klebsiella oxytoca

Jayol

Poirel

Villegas

et al. 2015

International Journal of Antimicrobial Agents

View full text Add to dashboard Cite

Gene modifications in the PmrAB and PhoPQ two-component regulatory systems, as well as inactivation of the mgrB gene, are known to be causes of colistin resistance in Klebsiella pneumoniae. The objective of this study was to characterise the mechanism involved in colistin resistance in a Klebsiella oxytoca isolate. A K. oxytoca clinical isolate showing resistance to colistin was recovered in Cali, Colombia. The pmrA, pmrB, phoP, phoQ and mgrB genes were amplified and sequenced. Wild-type mgrB genes from K. pneumoniae and K. oxytoca were cloned, and corresponding recombinant plasmids were used for complementation assays. By analysing the mgrB gene of the K. oxytoca isolate and its flanking sequences, an insertion sequence (IS) of 1196 bp was identified in its promoter region. The insertion was located between nucleotides −39 and −38 when referring to the start codon of the mgrB gene, thus negatively interfering with expression of the mgrB gene by modifying its promoter structure. This IS was very similar to ISKpn26 (99% nucleotide identity) belonging to the IS5 family. Complementation assays with mgrB genes from wild-type K. pneumoniae or K. oxytoca restored full susceptibility to colistin. In conclusion, here we identified the mechanism involved in colistin resistance in a K. oxytoca isolate. Modulation of mgrB gene expression was the key factor for this acquired resistance to colistin.

show abstract

Outbreak of OXY-2-Producing Klebsiella oxytoca in a Renal Transplant Unit

Cited by 26 publications

References 20 publications

Epidemiology of Klebsiella oxytoca-Associated Diarrhea Detected by Simmons Citrate Agar Supplemented with Inositol, Tryptophan, and Bile Salts

Epidemiology of Klebsiella oxytoca-Associated Diarrhea Detected by Simmons Citrate Agar Supplemented with Inositol, Tryptophan, and Bile Salts

Contaminated Handwashing Sinks as the Source of a Clonal Outbreak of KPC-2-Producing Klebsiella oxytoca on a Hematology Ward

Modulation of mgrB gene expression as a source of colistin resistance in Klebsiella oxytoca

Contact Info

Product

Resources

About