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Title
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International prospective study of **Klebsiella pneumoniae** bacteremia: implications of extended-spectrum ß-lactamase production in nosocomial infections
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Author
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Abstract
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| Background: Commonly encountered nosocomially acquired gram-negative bacteria, especially Klebsiella pneumoniae, produce extended-spectrum ß-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 ß-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. |
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Language
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English
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Source (journal)
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Annals of internal medicine / American College of Physicians. - Philadelphia, Pa, 1927, currens
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Publication
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Philadelphia, Pa
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2004
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ISSN
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0003-4819
1539-3704
[online]
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DOI
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10.7326/0003-4819-140-1-200401060-00008
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Volume/pages
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140
:1
(2004)
, p. 26-32
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ISI
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000187855600004
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Full text (Publisher's DOI)
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