Extended-Spectrum β-Lactamase-Producing<i>Klebsiella</i><i>pneumoniae</i>in a Neonatal Intensive Care Unit in the High-Prevalence Area of Athens, Greece

Lebessi, Evangelia; Dellagrammaticas, H D; Tassios, Panayotis T.; Tzouvelekis, L. S.; Ioannidou, S.; Foustoukou, M.; Legakis, N. J.

doi:10.1128/jcm.40.3.799-804.2002

Cited by 33 publications

(17 citation statements)

References 20 publications

(14 reference statements)

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“…When further epidemics occurred in 2001-02 and 2002-03, mortality associated with bacterial infections increased threefold, and the pathogen K. pneumoniae was isolated in pure culture from almost all pups examined at necropsy . Species of Klebsiella are widespread pathogens capable of causing severe nosocomial outbreaks in humans hospitalized in intensive care units and in neonatal wards resulting in septicemia (Peñ a et al, 1998;Lebessi et al, 2002). Species of Klebsiella have been commonly cultured from various internal tissues in marine mammals (Stroud and Roffe, 1979;Vedros et al, 1982;Baker and McCann, 1989;Herná ndez-Castro et al, 2005) and in a vast range of wild birds, reptiles, and terrestrial mammals (Bartoszcze et al, 1990;Aguirre et al, 1994;Montgomery et al, 2002;Steele et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Neonatal Mortality in New Zealand Sea Lions (Phocarctos Hookeri ) at Sandy Bay, Enderby Island, Auckland Islands From 1998 to 2005

Castinel

Duignan

Pomroy

et al. 2007

Journal of Wildlife Diseases

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ABSTRACT:As part of a health survey of New Zealand sea lions (Phocarctos hookeri) on Enderby Island, Auckland Islands (50u309S, 166u179E), neonatal mortality was closely monitored at the Sandy Bay colony for seven consecutive years. Throughout the breeding seasons 1998-99 to 2004-05, more than 400 postmortem examinations were performed on pups found dead at this site. The primary causes of death were categorized as trauma (35%), bacterial infections (24%), hookworm infection (13%), starvation (13%), and stillbirth (4%). For most pups, more than one diagnosis was recorded. Every year, two distinct peaks of trauma were observed: the first associated with mature bulls fighting within the harem and the second with subadult males abducting pups. In 2001-02 and 2002-03, epidemics caused by Klebsiella pneumoniae increased mortality by three times the mean in nonepidemic years (10.2%). The increased mortality was attributed directly to acute suppurative infection due to the bacterium and also to an increase in traumatic deaths of debilitated pups. Parasitic infection with the hookworm Uncinaria spp. was a common finding in all pups older than three weeks of age and debilitation by the parasite may have contributed to increased susceptibility to other pathogens such as Klebsiella sp. or Salmonella sp. This study provides valuable quantitative data on the natural causes of neonatal mortality in New Zealand sea lions that can be used in demographic models for management of threatened species.

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Section: Discussionmentioning

confidence: 99%

Neonatal Mortality in New Zealand Sea Lions (Phocarctos Hookeri ) at Sandy Bay, Enderby Island, Auckland Islands From 1998 to 2005

Castinel

Duignan

Pomroy

et al. 2007

Journal of Wildlife Diseases

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“…Pulsed-field gel electrophoresis of chromosomal DNA is probably the most widely used method of genotyping ESBL-producing organisms (15,17,57,68,85,113,128,132,149,207,218,222,234,235,256,268,298,328,334,341,348,351,358,374,381,408,426,431,439). These references describe the restriction enzymes used for various organisms harboring ESBLs.…”

Section: Use Of Typing Methodsmentioning

confidence: 99%

Extended-Spectrum β-Lactamases: a Clinical Update

2005

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SUMMARY Extended-spectrum β-lactamases (ESBLs) are a rapidly evolving group of β-lactamases which share the ability to hydrolyze third-generation cephalosporins and aztreonam yet are inhibited by clavulanic acid. Typically, they derive from genes for TEM-1, TEM-2, or SHV-1 by mutations that alter the amino acid configuration around the active site of these β-lactamases. This extends the spectrum of β-lactam antibiotics susceptible to hydrolysis by these enzymes. An increasing number of ESBLs not of TEM or SHV lineage have recently been described. The presence of ESBLs carries tremendous clinical significance. The ESBLs are frequently plasmid encoded. Plasmids responsible for ESBL production frequently carry genes encoding resistance to other drug classes (for example, aminoglycosides). Therefore, antibiotic options in the treatment of ESBL-producing organisms are extremely limited. Carbapenems are the treatment of choice for serious infections due to ESBL-producing organisms, yet carbapenem-resistant isolates have recently been reported. ESBL-producing organisms may appear susceptible to some extended-spectrum cephalosporins. However, treatment with such antibiotics has been associated with high failure rates. There is substantial debate as to the optimal method to prevent this occurrence. It has been proposed that cephalosporin breakpoints for the Enterobacteriaceae should be altered so that the need for ESBL detection would be obviated. At present, however, organizations such as the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards) provide guidelines for the detection of ESBLs in klebsiellae and Escherichia coli. In common to all ESBL detection methods is the general principle that the activity of extended-spectrum cephalosporins against ESBL-producing organisms will be enhanced by the presence of clavulanic acid. ESBLs represent an impressive example of the ability of gram-negative bacteria to develop new antibiotic resistance mechanisms in the face of the introduction of new antimicrobial agents.

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“…Many outbreaks of K. pneumoniae infections in the NICU have frequently been shown to have an environmental reservoir. 4,5 Irrespective of the primary source, the lower digestive tract of the colonised neonates is the main reservoir of these micro-organisms, and cross contamination is presumably hand carried by the attending staff. 6 It was noted that during the year 2002, the incidence of neonatal septicemia due to ESβL producing K. pneumoniae increased more than 2 fold in the NICU at Karnataka Institute of Medical Sciences Hospital, Hubli, India.…”

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confidence: 99%

Extended Spectrum β Lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

2007

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Widespread use of third generation cephalosporins as a pre-emptive antibiotic for suspected cases of septicaemia may have contributed to emergence of ESbetaL producing K. pneumoniae in addition to other risk factors. ESbetaL producing K. pneumoniae have extensively colonised the environment of the NICU. Transmission of these pathogens to the neonates has probably occurred through the healthcare workers. Efforts to improve hand hygiene among the healthcare workers and mothers are urgently needed.

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Extended-Spectrum β-Lactamase-ProducingKlebsiellapneumoniaein a Neonatal Intensive Care Unit in the High-Prevalence Area of Athens, Greece

Cited by 33 publications

References 20 publications

Neonatal Mortality in New Zealand Sea Lions (Phocarctos Hookeri ) at Sandy Bay, Enderby Island, Auckland Islands From 1998 to 2005

Neonatal Mortality in New Zealand Sea Lions (Phocarctos Hookeri ) at Sandy Bay, Enderby Island, Auckland Islands From 1998 to 2005

Extended-Spectrum β-Lactamases: a Clinical Update

Extended Spectrum β Lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

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