Risk Factors for Colonization and Infection in a Hospital Outbreak Caused by a Strain of
            <i>Klebsiella pneumoniae</i>
            with Reduced Susceptibility to Expanded-Spectrum Cephalosporins

Cartelle, Mónica; Tomás, María; Pértega, Sonia; Beceiro, Alejandro; Domı́nguez, M.A.; Velasco, David; Molina, Francisca; Villanueva, Rosa; Bou, Germán

doi:10.1128/jcm.42.9.4242-4249.2004

Cited by 46 publications

(26 citation statements)

References 29 publications

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“…Antimicrobial use has historically been associated with the emergence of ESBL-producing strains of the family Enterobacteriaceae (5,7,10), and this finding is confirmed by our multivariate analysis. Antibiotic therapy promotes the colonization or infection of the treated patient by resistant organisms by eradicating susceptible strains and modifying the host's resistance to colonization.…”

Section: Discussionsupporting

confidence: 77%

“…These outbreaks often occur in ICUs (32,34,41), presumably because patients in these areas often have a relatively high number of risk factors for colonization or infection with these organisms. Factors such as severe clinical status, advanced age, misuse or abuse (or even appropriate use) of antimicrobial agents, the high frequency of invasive procedures, and the high workloads in ICUs can all reduce patients' resistance to exogenous bacteria, increasing the risk for cross-infection (2,5,8,10,21,23) and creating an ideal reservoir for multiple-drug-resistant K. pneumoniae. The reported prevalence of ESBL-producing K. pneumoniae among isolates recovered from ICU patients varies from 9% to 59% (34,41).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae : Risk Factors, Molecular Epidemiology, and Clinical Outcome

Tumbarello¹,

Spanu²,

Sanguinetti³

et al. 2006

Antimicrob Agents Chemother

256

201

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Bloodstream infections caused by extended-spectrum-␤-lactamase (ESBL)-producing Klebsiella pneumoniae isolates are a major concern for clinicians, since they markedly increase the rates of treatment failure and death. One hundred forty-seven patients with K. pneumoniae bloodstream infections were identified over a 5-year period (January 1999 to December 2003). The production of ESBLs in bloodstream isolates was evaluated by molecular methods. A retrospective case-case-control study was conducted to identify risk factors for the isolation of ESBLproducing K. pneumoniae or non-ESBL-producing K. pneumoniae isolates in blood cultures. Forty-eight cases infected with ESBL-producing K. pneumoniae isolates and 99 cases infected with non-ESBL-producing K. pneumoniae isolates were compared to controls. Risk factors for isolation of ESBL-producing K. pneumoniae isolates were exposure to antibiotic therapy (odds ratio [OR], 11.81; 95% confidence interval [CI], 2.72 to 51.08), age (OR, 1.14; 95% CI, 1.08 to 1.21), and length of hospitalization (OR, 1.10; 95% CI, 1.04 to 1.16). Independent determinants for isolation of non-ESBL-producing K. pneumoniae were previous urinary tract infection (OR, 8.50; 95% CI, 3.69 to 19.54) and length of hospitalization (OR, 1.07; 95% CI, 1.04 to 1.10). When the initial response was assessed at 72 h after antimicrobial therapy, the treatment failure rate for the ESBL-producing K. pneumoniae-infected group was almost twice as high as that of the non-ESBL-producing K. pneumoniae-infected group (31% versus 17%; OR, 2.19; 95% CI, 0.98 to 4.89). The 21-day mortality rate for all patients was 37% (54 of 147); it was 52% (25 of 48) for patients with ESBL-producing K. pneumoniae bloodstream infections and 29% (29 of 99) for patients with non-ESBLproducing K. pneumoniae bloodstream infections (OR, 2.62; 95% CI, 1.28 to 5.35). In summary, this investigation identifies epidemiological characteristics that distinguish ESBL-producing K. pneumoniae infections from non-ESBL-producing K. pneumoniae ESBL bloodstream infections.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae : Risk Factors, Molecular Epidemiology, and Clinical Outcome

Tumbarello¹,

Spanu²,

Sanguinetti³

et al. 2006

Antimicrob Agents Chemother

256

201

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“…In one month 14, 950 patients were prescribed with antibiotics-a total of 2915 hundred doses. Exclusively 1095 hundred doses had been distributed by pharmacies, and an extra 100 doses had been distributed as over the counter drugs [3].…”

Section: How Are Antimicrobial Drugs Used?mentioning

confidence: 99%

A Review on Antimicrobial Resistance in Developing Countries

Ravalli¹,

CH²

2015

Biochem Pharmacol

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“…Three hundred twenty-two A. baumannii consecutive isolates obtained at University Hospital A Coruña (collected from 2001 to 2011) and from the bacterial collection of the Spanish Network for Research in Infectious Diseases were analyzed. Repetitive extragenic palindromic (REP)-PCR was performed in some cases to rule out clonality (2). Moreover, two reference strains obtained from the American Type Culture Collection (ATCC, Manassas, VA), ATCC 17978 and ATCC 19606, showing meropenem and ciprofloxacin susceptibility, were also assayed.…”

Section: Methodsmentioning

confidence: 99%

Fast Assessment of Resistance to Carbapenems and Ciprofloxacin of Clinical Strains of Acinetobacter baumannii

et al. 2012

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dInfections caused by multidrug-resistant Acinetobacter baumannii constitute a major life-threatening problem worldwide, and early adequate antibiotic therapy is decisive for success. For these reasons, rapid detection of antibiotic susceptibility in this pathogen is a clinical challenge. Two variants of the Micromax kit were evaluated for a rapid detection in situ of susceptibility or resistance to meropenem or ciprofloxacin, separately, in 322 clinical isolates. Release of the nucleoid is the criterion of susceptibility to the beta-lactams (carbapenems), whereas diffusion of DNA fragments emerging from the nucleoid characterizes the quinolone activity. All the susceptible and resistant strains were correctly categorized in 100 min according to the MIC results and CLSI criteria. Thus, our technology is a promising tool for rapid identification of carbapenem and quinolone resistance of A. baumannii strains in hospital settings.

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Risk Factors for Colonization and Infection in a Hospital Outbreak Caused by a Strain of Klebsiella pneumoniae with Reduced Susceptibility to Expanded-Spectrum Cephalosporins

Cited by 46 publications

References 29 publications

Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae : Risk Factors, Molecular Epidemiology, and Clinical Outcome

Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae : Risk Factors, Molecular Epidemiology, and Clinical Outcome

A Review on Antimicrobial Resistance in Developing Countries

Fast Assessment of Resistance to Carbapenems and Ciprofloxacin of Clinical Strains of Acinetobacter baumannii

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