Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-24T13:08:16.727Z Has data issue: false hasContentIssue false
  • English
  • Français

Increased Mortality Associated With a Clonal Outbreak of Ceftazidime-Resistant Klebsiella pneumoniae: A Case–Control Study

Published online by Cambridge University Press:  21 June 2016

Abdul Qavi ,
Sorana Segal-Maurer ,
Noriel Mariano ,
Carl Urban ,
Carl Rosenberg ,
Janice Burns ,
Tom Chiang ,
James Maurer  and
James J. Rahal
Abdul Qavi
Affiliation:
Infectious Disease Section and the Department of Medicine, New York Hospital Medical Center of Queens, Flushing, New York
Sorana Segal-Maurer*
Affiliation:
Infectious Disease Section and the Department of Medicine, New York Hospital Medical Center of Queens, Flushing, New York Department of Medicine, Weill Medical College of Cornell University, New York, New York
Noriel Mariano
Affiliation:
Infectious Disease Section and the Department of Medicine, New York Hospital Medical Center of Queens, Flushing, New York
Carl Urban
Affiliation:
Infectious Disease Section and the Department of Medicine, New York Hospital Medical Center of Queens, Flushing, New York Department of Microbiology, Weill Medical College of Cornell University, New York, New York
Carl Rosenberg
Affiliation:
Department of Emergency Medicine, New York Hospital Medical Center of Queens, Flushing, New York
Janice Burns
Affiliation:
Department of Nursing, New York Hospital Medical Center of Queens, Flushing, New York
Tom Chiang
Affiliation:
Infectious Disease Section and the Department of Medicine, New York Hospital Medical Center of Queens, Flushing, New York
James Maurer
Affiliation:
Department of Surgery, New York Hospital Medical Center of Queens, Flushing, New York
James J. Rahal
Affiliation:
Infectious Disease Section and the Department of Medicine, New York Hospital Medical Center of Queens, Flushing, New York Department of Medicine, Weill Medical College of Cornell University, New York, New York
*
Infectious Disease Section, New York Hospital Medical Center of Queens, 56-45 Main Street, Flushing, NY 11355sxsegalm@nyp.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To determine risk factors for ceftazidime-resistant Klebsiella pneumoniae infection and the effect of cef-tazidime-resistant K. pneumoniae infection on mortality during an isolated outbreak.

Design:

Case–control investigation using clinical and molecular epidemiology and prospective analysis of infection control interventions.

Setting:

Surgical intensive care unit of a university-affiliated community hospital.

Patients:

Fourteen case-patients infected with ceftazidime-resistant K. pneumoniae and 14 control-patients.

Results:

Ten of 14 case-patients had identical strains by pulsed-field gel electrophoresis. Broad-spectrum antibiotic therapy before admission to the unit was strongly predictive of subsequent ceftazidime-resistant K. pneumoniae infection. In addition, patients with ceftazidime-resistant K. pneumoniae infection experienced increased mortality (odds ratio, 3.77).

Conclusions:

Cephalosporin restriction has been shown to decrease the incidence of nosocomial ceftazidime-resistant K. pneumoniae. However, isolated clonal outbreaks may occur due to lapses in infection control practices. Reinstatement of strict handwashing, thorough environmental cleaning, and repeat education led to termination of the outbreak. A distinct correlation between ceftazidime-resistant K. pneumoniae infection and mortality supports the important influence of antibiotic resistance on the outcome of serious bacterial infections.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 1 , January 2005 , pp. 63 - 68
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hibbert-Rogers, LCF, Heritage, J, Gascoyne-Binzi, DM, et al.Molecular epidemiology of ceftazidime resistant Enterobacteriaceae from patients on a paediatric oncology ward. J Antimicrob Chemother 1996;36:65–82.Google Scholar
2.Jacoby, GA. Extended-spectrum beta-lactamases and other enzymes providing resistance to oxymino-beta-lactams. Infect Dis Clin North Am 1997;11:875–887.Google Scholar
3.Gaillot, O, Maruejouls, C, Abachin, E, et al.Nosocomial outbreak of Klebsiella pneumoniae producing SHV-5 extended-spectrum beta-lacta-mase, originating from a contaminated ultrasonography coupling gel. J Clin Microbiol 1998;36:1357–1360.Google Scholar
4.Gniadkowski, M, Palucha, A, Grzesiowski, P, Hryniewicz, W. Outbreak of ceftazidime-resistant Klebsiella pneumoniae in a pediatric hospital in Warsaw, Poland: clonal spread of the TEM-47 extended-spectrum beta-lactamase (ESBL)-producing strain and transfer of a plasmid carrying the SHV-5-like ESBL-encoding gene. Antimicrob Agents Chemother 1998;42:3079–3085.Google Scholar
5.Lucet, J-C, Decré, D, Fichelle, A, et al.Control of prolonged outbreak of extended-spectrum beta-lactamase-producing Enterobacteriaceae in a university hospital. Clin Infect Dis 1999;29:1411–1418.Google Scholar
6.Bradford, PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat Clin Microbiol Rev 2001;14:933–951.CrossRefGoogle ScholarPubMed
7.Meyer, KS, Urban, C, Eagan, JA, Berger, BJ, Rahal, JJ. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993;119:353–358.CrossRefGoogle ScholarPubMed
8.Lucet, J-C, Chevret, S, Decré, D, et al.Outbreak of multiply resistant Enterobacteriaceae in an intensive care unit: epidemiology and risk factors for acquisition. Clin Infect Dis 1996;22:430–436.Google Scholar
9.Asensio, A, Oliver, A, Gonzalez-Diego, P, et al.Outbreak of a multiresis-tant Klebsiella pneumoniae strain in an intensive care unit: antibiotic use as a risk factor for colonization and infection. Clin Infect Dis 2000;30:55–60.Google Scholar
10.Urban, C, Meyer, KS, Mariano, N, et al.Identification of TEM-26 beta-lactamase responsible for a major outbreak of ceftazidime-resistant Klebsiella pneumoniae. Antimicrob Agents Chemother 1994;38:392–395.Google Scholar
11.Rahal, JJ, Urban, C, Horn, D, et al.Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella. JAMA 1998;280:1233–1237.Google Scholar
12.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: National Committee for Clinical Laboratory Standards; 1997. Approved standard M100-S8.Google Scholar
13.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
14.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
15.Goldmann, DA, Weinstein, RA, Wenzel, RP, et al.Strategies to prevent and control the emergence and spread of anti-microbial resistant microorganisms in hospitals: a challenge to hospital leadership. JAMA 1996;275:234–240.Google Scholar
16.Schiappa, DA, Hayden, MK, Matushek, MG, et al.Ceftazidime-resistant Klebsiella pneumoniae and Escherichia coli bloodstream infection: a case-control and molecular epidemiologic investigation. J Infect Dis 1996;174:529–536.Google Scholar
17.Lautenbach, E, Patel, JB, Bilker, WB, Edelstein, PH, Fishman, NO. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;32:1162–1171.Google Scholar
18.Kollef, MH, Fraser, VJ. Antibiotic resistance in the intensive care unit Ann Intern Med 2001;132:298–314.Google Scholar
19.Haley, RW, Bregman, DA. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis 1982;145:875–885.Google Scholar
20.Fridkin, SK, Pear, SM, Williamson, TH, Galgiani, JN, Jarvis, WR. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996;17:150–158.Google ScholarPubMed
21.Archibald, LK, Manning, ML, Bell, LM, Banerjee, S, Jarvis, WR. Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis 1997;16:1045–1048.Google Scholar
22.Tarnow-Mordi, WO, Hau, C, Warden, A, Shearer, AJ. Hospital mortality in relation to staff workload: a 4 year study in an adult intensive-care unit. Lancet 2000;356:185–189.Google Scholar
23.Urban, C, Mariano, N, Wehbeh, W, Rosenberg, C, Rahal, JJ. Molecular epidemiology of ceftazidime-susceptible Klebsiella pneumoniae (CSKp) and ceftazidime-resistant Klebsiella pneumoniae (CRKP) in a tertiary care hospital: a four-year survey. Presented at the 38th Annual Meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy; September 24-27,1998; San Diego, CA.Google Scholar
24.French, GL, Shannon, KP, Simmons, N. Hospital outbreak of Klebsiella pneumoniae resistant to broad-spectrum cephalosporins and beta-lac-tam-beta-lactamase inhibitor combinations by hyperproduction of SHV-5 beta-lactamase. J Clin Microbiol 1996;34:358–363.Google Scholar
25.Rice, LB, Eckstein, EC, DeVente, J, Shlaes, DM. Ceftazidime-resistant Klebsiella pneumoniae isolates recovered at the Cleveland Department of Veterans Affairs Medical Center. Clin Infect Dis 1996;23:118–124.Google Scholar
26.Piroth, L, Aubé, H, Doise, J-M, Vincent-Martin, M. Spread of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: are beta-lactamase inhibitors of therapeutic value? Clin Infect Dis 1998;27:76–80.Google Scholar
27.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126–130.Google Scholar
28.Edmond, MB, Wallace, SE, McClish, DK, Pfaller, MA, Jones, RN, Wenzel, RRNosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis 1999;29:239–244.CrossRefGoogle ScholarPubMed
29.Ahmad, M, Urban, C, Mariano, N, et al.Clinical characteristics and molecular epidemiology associated with imipenem-resistant Klebsiella pneumoniae. Clin Infect Dis 1999;29:352–355.Google Scholar
30.Adedeji, A, Landman, D, Mayorga, D, et al.Impact of antimicrobial resistance on outcome of hospitalized patients with infections due to S aureus and K pneumoniae. Presented at the 38th Annual Meeting of the Infectious Diseases Society of America; September 7-10, 2000; New Orleans, LA.Google Scholar
31.Tsay, RW, Siu, LK, Fung, CP, Chang, FY. Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection. Arch Intern Med 2002;162:1021–1027.Google Scholar
32.Kim, YK, Pai, H, Lee, HJ, et al.Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome. Antimicrob Agents Chemother 2002;46:1481–1491.Google Scholar
33.Larson, E. Skin hygiene and infection prevention: more of the same or different approaches? Clin Infect Dis 1999;29:1287–1294.Google Scholar
34.Larson, EL, Aiello, AE, Bastyr, J, et al.Assessment of two hand hygiene regimens for intensive care unit personnel. Crit Care Med 2001;29:1083–1084.Google Scholar
35.Urban, C, Segal-Maurer, S, Rahal, JJ. Considerations in control and treatment of nosocomial infections due to multidrug-resistant Acinetobacter baumannii. Clin Infect Dis 2003;36:1268–1274.Google Scholar