Long-term clinical and economic benefits associated with the management of a nosocomial outbreak resulting from extended-spectrum beta-lactamase-producing Klebsiella pneumoniae

Piednoir, E.; Thibon, Pascal; Borderan, Guy-Claude; Godde, Frédéric; Borgey, F.; Coutour, X. Le; Parienti, Jean‐Jacques

doi:10.1097/ccm.0b013e31822827e0

Cited by 19 publications

(7 citation statements)

References 38 publications

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“…Extended-spectrum beta-lactamase-producing Enterobacteriaceae can spread between humans via contaminated food or water ( Oteo et al, 2010 ; Piednoir et al, 2011 ) and acquire resistance to antibiotics by plasmids, transposons or other mobile vectors that carry resistance elements ( Oteo et al, 2010 ; Peirano et al, 2012 ). Water environments are considered as important reservoirs for resistance genes ( Gao et al, 2009 ), and maybe play an important role in transfer of drug-resistant genes between bacteria ( Malakoff, 2002 ; Kummerer, 2004 ).…”

Section: Introductionmentioning

confidence: 99%

Multidrug resistance found in extended-spectrum beta-lactamase-producing Enterobacteriaceae from rural water reservoirs in Guantao, China

et al. 2015

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Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have been isolated from humans and animals across the world. However, data on prevalence of ESBL-producing Enterobacteriaceae from rural water reservoirs is limited. This study aimed to isolate and characterize ESBL-producing Enterobacteriaceae in rural water reservoirs in Guantao, China. ESBL-producing Enterobacteriaceae were found in 5 (16.7%) of 30 sampled rural water reservoirs. Sixty-six individual isolates expressing an ESBL phenotype were obtained in the present study. Species identification showed that 42 representatives of Escherichia coli, 17 Klebsiella pneumoniae, 4 Raoultella planticola, and 3 Enterobacter cloacae. Twenty isolates contained a single bla gene, including CTX-M (17 strains), TEM (2 strains), and SHV (1 strain). Forty-six isolates contained more than one type of beta-lactamase genes. ESBL-producing Enterobacteriaceae isolated in this study were all multidrug resistant. These findings indicated that the serious contamination of ESBL-producing Enterobacteriaceae in rural water reservoirs existed in Guantao, China.

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Section: Introductionmentioning

confidence: 99%

Multidrug resistance found in extended-spectrum beta-lactamase-producing Enterobacteriaceae from rural water reservoirs in Guantao, China

et al. 2015

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“…Because K. pneumoniae rapidly develops multidrug-resistant strains, this "superbug" can also cause outbreaks in intensive care units, imposing significant financial burdens and dangerous health threats (2,3). Despite intensive research during the past few decades, the pathogenesis of K. pneumoniae, including its internalization of alveolar cells, is incompletely understood.…”

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confidence: 99%

Lipid-Based Signaling Modulates DNA Repair Response and Survival against Klebsiella pneumoniae Infection in Host Cells and in Mice

Huang

Weaver

et al. 2013

Am J Respir Cell Mol Biol

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Klebsiella pneumoniae causes serious infections in the urinary tract, respiratory tract, and blood. Lipid rafts, also known as membrane microdomains, have been linked to the pathogenesis of bacterial infection. However, whether lipid rafts affect K. pneumoniae internalization into host cells remains unknown. Here, we show for the first time that K. pneumoniae was internalized into lung cells by activating lipid rafts. Disrupting lipid rafts by methyl-b-cyclodextrin inhibited pathogen internalization, impairing host defense. A deficient mutant of capsule polysaccharide (CPS) showed a higher internalization rate than a wild-type strain, indicating that CPS may inhibit bacterial entry to host cells. Furthermore, lipid rafts may affect the function of extracellular regulated kinase (ERK)-1/2, and knocking down ERK1/ 2 via short, interfering RNA increased apoptosis in both alveolar macrophages and epithelial cells after infection. To gain insights into bacterial pathogenesis, we evaluated the impact of lipid rafts on DNA integrity, and showed that raft aggregates also affect DNA damage and DNA repair responses (i.e., 8-oxoguanine DNA glycosylase [Ogg1]) through the regulation of reactive oxygen species. Importantly, cells overexpressing Ogg1 demonstrated reduced cytotoxicity during bacterial infection. Taken together, these results suggest that lipid rafts may modulate bacterial internalization, thereby affecting DNA damage and repair, which is critical to host defense against K. pneumoniae.Keywords: Klebsiella pneumoniae infection; internalization; alveolar epithelial cells; lipid rafts; capsule polysaccharide Klebsiella pneumoniae causes serious infections in multiorgan systems, and is the third most commonly isolated bacterium from the blood of patients with sepsis (1). Because K. pneumoniae rapidly develops multidrug-resistant strains, this "superbug" can also cause outbreaks in intensive care units, imposing significant financial burdens and dangerous health threats (2, 3). Despite intensive research during the past few decades, the pathogenesis of K. pneumoniae, including its internalization of alveolar cells, is incompletely understood. K. pneumoniae expresses two critical antigens on its cell surface, LPS (an O antigen) and capsule polysaccharide (CPS; a K antigen) (4). These two antigens contribute to pathogenicity through interactions with host cells in different manners (5). LPS is a major component of Gramnegative bacterial cell walls with high immunogenicity, but its role in pathogenesis remains elusive. Early studies suggest that LPS-deficient strains failed to show significantly different pathogenesis from the wild-type (WT) strain (5). By contrast, CPS demonstrates the most distinguished characteristic of virulence factors for K. pneumoniae, and is implicated in the internalization of pathogens into epithelial cells (6). The capsule may protect the bacterium from phagocytosis by macrophages, through an escape from bactericidal serum factors (6). Other studies also demonstrated that isogenic CPS mutant...

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“…Fifty-four nosocomial infections were prevented with a cost savings of $191,379 to $343,974 [24]. Their experience is the only report in the medical literature thus far of the impact of outbreak response on the incidence of new nosocomial infections.…”

Section: Discussionmentioning

confidence: 95%

“…Piednoir et al [24] reported their institution's response to resistant Klebsiella pneumoniae in a mixed medical-surgical ICU and the impact of their response on the incidence of nosocomial infections. Fifty-four nosocomial infections were prevented with a cost savings of $191,379 to $343,974 [24].…”

Section: Discussionmentioning

confidence: 99%

Differential Impact of Infection Control Strategies on Rates of Resistant Hospital-Acquired Pathogens in Critically Ill Surgical Patients

Jayaraman

Askari

Bascom

et al. 2014

Surgical Infections

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Long-term clinical and economic benefits associated with the management of a nosocomial outbreak resulting from extended-spectrum beta-lactamase-producing Klebsiella pneumoniae

Cited by 19 publications

References 38 publications

Multidrug resistance found in extended-spectrum beta-lactamase-producing Enterobacteriaceae from rural water reservoirs in Guantao, China

Multidrug resistance found in extended-spectrum beta-lactamase-producing Enterobacteriaceae from rural water reservoirs in Guantao, China

Lipid-Based Signaling Modulates DNA Repair Response and Survival against Klebsiella pneumoniae Infection in Host Cells and in Mice

Differential Impact of Infection Control Strategies on Rates of Resistant Hospital-Acquired Pathogens in Critically Ill Surgical Patients

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