Endemic Extended-Spectrumβ-Lactamase-producingKlebsiella pneumoniaeat an Intensive Care Unit: Risk Factors for Colonization and Infection

Abstract

A prospective cohort study was undertaken to describe the epidemiology of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBLKp) acquisition at an intensive care unit (ICU) in a non-outbreak setting. Surveillance for ESBLKp colonization and infection was performed in patients admitted at the ICU from January, 2000, to May, 2001. Screening for ESBLKp intestinal colonization was done by culturing rectal swab specimens at admission, 72 hr after admission and weekly until discharge or detection of ESBLKp. The incidence of ESBLKp intestinal colonization was 5.8/1,000 patient-days (95%CI, 3.4-10.1), and of ESBLKp infection was 1.7/1,000 patient-days (95%CI, 0.7-4.2). Use of vancomycin (OR 6.6; 95%CI, 1.73-25.28), amphotericin B (OR 12.0; 95%CI, 1.79-80.51), metronidazole (OR 5.3; 95%CI, 1.10-25.65), and ciprofloxacin (OR 0.1; 95%CI, 0.01-0.97) were independently associated with ESBLKp intestinal colonization. Previous ESBLKp colonization (OR 60.6; 95%CI, 56.33-578.73) was independently associated with ESBLKp infection. Each ICU-acquired ESBLKp isolate belonged to a different genotype by ERIC-PCR or pulsed-field gel electrophoresis (PFGE) and had a different plasmid profile, suggesting that cross transmission was not the main source for ESBLKp acquisition. Factors associated with ESBLKp in the non-outbreak setting were different from those previously reported during outbreaks. Intestinal ESBLKp colonization was confirmed as a risk factor for infection by this pathogen.

Risk factors for and mortality of extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli nosocomial bloodstream infections

“…Extended-spectrum-ß-lactamases (ESBLs) have emerged worldwide as a major determinant of antimicrobial penicillin, cephalosporin and aztreonam resistance among these Gram-negative bacteria 19 . As occurs in many Brazilian hospitals 7,14,16 , ESBL-producing organisms are endemic and highly prevalent in our institution.…”

“…ESBL-producing organisms are a clinical problem worldwide, particularly in Latin American countries and especially in Brazil, where high endemic rates of ESBL-producing Enterobacteriaceae have been determined 7,14,16 . In our institution, high endemic rates have also been observed over the last 10 years.…”

Extended-spectrum β lactamase-producing gram-negative bacteria: clinical profile and outcome in a neonatal intensive care unit

“…21 Ciprofloxacin has been seen to be independently protective against ESBL K. pneumoniae colonisation (OR 0.1, 95% CI 0.0-0.97), in contrast with vancomycin (OR 6.6, 95% CI 1.73-25.28), amphotericin B (OR 12.0, 95% CI 1.79-80.5) and metronidazole (OR 5.3, 95% CI 1.1-25.6). 22 Moreover, fluoroquinolones can also reduce the current dependence on carbapenem agents and limit the potential for further emergence of carbapenem resistance. 23,24 In our unit, therefore, fluoroquinolones are used as a reserve drug when others cannot be used because of lack of sensitivity, adverse effects or for economic reasons and when the sensitivity to fluoroquinolones is well documented.…”

Emergence of Resistant Klebsiella pneumoniae in the Intestinal Tract during Successful Treatment of Klebsiella pneumoniae Lung Infection in Rats

“…Klebsiella pneumoniae is an important opportunistic pathogen implicated in nosocomial bacterial infections (19). Epidemiological studies have shown that the majority of K. pneumoniae infections are often preceded by colonization of the patient's gastrointestinal tract by the bacteria (9,10). Recent reports suggest that fluoroquinolone-resistant Klebsiella pneumoniae isolates are common in many long-term care facilities and hospitals and are often associated with multidrug-resistant phenotypes (11,22).…”