International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum beta-lactamase production in nosocomial Infections.

Abstract

BACKGROUND:

Commonly encountered nosocomially acquired gram-negative bacteria, especially Klebsiella pneumoniae, produce extended-spectrum beta-lactamases (ESBLs) as an antibiotic resistance mechanism.

OBJECTIVE:

To determine whether microbiology laboratories should report the presence of ESBLs and to establish the infection-control implications of ESBL-producing organisms.

DESIGN:

Prospective observational study.

SETTING:

12 hospitals in South Africa, Taiwan, Australia, Argentina, the United States, Belgium, and Turkey.

PATIENTS:

440 patients with 455 consecutive episodes of K. pneumoniae bacteremia between 1 January 1996 and 31 December 1997; of these, 253 episodes were nosocomially acquired.

MEASUREMENTS:

The K. pneumoniae isolates were examined for the presence of ESBLs. Pulsed-field gel electrophoresis was used to analyze the molecular epidemiology of nosocomial bacteremia with ESBL-producing K. pneumoniae.

RESULTS:

Overall, 30.8% (78 of 253) episodes of nosocomial bacteremia and 43.5% (30 of 69) episodes acquired in intensive care units were due to ESBL-producing organisms. After adjustment for potentially confounding variables, previous administration of beta-lactam antibiotics containing an oxyimino group (cefuroxime, cefotaxime, ceftriaxone, ceftazidime, or aztreonam) was associated with bacteremia due to ESBL-producing strains (risk ratio, 3.9 [95% CI, 1.1 to 13.8]). In 7 of 10 hospitals with more than 1 ESBL-producing isolate, multiple strains with the same genotypic pattern were observed, indicating patient-to-patient spread of the organism.

CONCLUSIONS:

Production of ESBLs by Klebsiella pneumoniae is a widespread nosocomial problem. Appropriate infection control and antibiotic management strategies are needed to stem the spread of this emerging form of resistance.

• Authors: David L Paterson, Wen-Chien Ko, Anne Von Gottberg, Sunita Mohapatra, Jose Maria Casellas, Herman Goossens, Lutfiye Mulazimoglu, Gordon Trenholme, Keith P Klugman, Robert A Bonomo, Louis B Rice, Marilyn M Wagener, Joseph G McCormack, Victor L Yu
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 140 Issue 1 Pg. 26-32 (Jan 06 2004) ISSN: 1539-3704 [Electronic] United States
• PMID: 14706969 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• beta-Lactamases

Topics

• Bacteremia (epidemiology, microbiology, prevention & control)
• Cross Infection (epidemiology, microbiology, prevention & control)
• Humans
• Intensive Care Units
• Klebsiella Infections (epidemiology, microbiology, prevention & control)
• Klebsiella pneumoniae (enzymology, genetics)
• Prospective Studies
• Risk Factors
• beta-Lactam Resistance
• beta-Lactamases (biosynthesis)