Journal Article

Clinical and Bacteriologic Epidemiology of Extended-Spectrum β-Lactamase-Producing Strains of <i>Klebsiella pneumoniae</i> in a Medical Intensive Care Unit

Dominique Decré, Bertrand Gachot, Jean Christophe Lucet, Guillaume Arlet and Eugénie Bergogne-Bérézin

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 27, issue 4, pages 834-844
Published in print October 1998 | ISSN: 1058-4838
Published online October 1998 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/514938
Clinical and Bacteriologic Epidemiology of Extended-Spectrum β-Lactamase-Producing Strains of Klebsiella pneumoniae in a Medical Intensive Care Unit

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The epidemiology of extended-spectrum b-lactamase (ESBL)-producing strains of Klebsiella pneumoniae was studied over a 16-month period in a medical intensive care unit (ICU). A control program involving enhanced isolation procedures, surveillance cultures at admission and then at 1- week intervals, and selective digestive decontamination (SDD) was instituted. Phenotypic and genotypic markers (plasmid content and DNA macrorestriction polymorphism determined by pulsedfield gel electrophoresis) were used to compare 138 strains of ESBL-producing K. pneumoniae. The incidence of colonization and/or infection with ESBL producers was 11.9%. ESBL-producing K. pneumoniae strains were isolated from 64 of 65 patients. Fifty-five cases were considered acquired in the ICU, while nine cases were imported. Forty-five infections occurred in 32 patients; 20 infections involved the urinary tract. SDD failed to reduce the incidence of acquisition of ESBL-producing K. pneumoniae. Combined use of markers was necessary to achieve accurate differentiation of strains. A single epidemic clone (SHV-4 β-lactamase-producing K. pneumoniae) was the cause of 85% of the ICU-acquired cases. Sporadic occurrence of SHV-5, TEM-3, SHV-2, and SHV-3 producers accounted only for a few cases.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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