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Antimicrobial Agents and Chemotherapy, January 1998, p. 53-58, Vol. 42, No. 1
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Epidemiology and Successful Control of a Large Outbreak Due to Klebsiella pneumoniae Producing ExtendedSpectrum beta -Lactamases

Carmen Peña,1,* Miquel Pujol,1 Carmen Ardanuy,2 Asumpta Ricart,3 Roman Pallares,1 Josefina Liñares,2 Javier Ariza,1 and Francisco Gudiol1

Infectious Disease Service,1 Microbiology Service,2 and Intensive Care Unit Service,3 Hospital de Bellvitge, Universidad de Barcelona, Barcelona, Spain

Received 18 August 1997/Returned for modification 8 September 1997/Accepted 21 October 1997

An outbreak due to extended-spectrum beta -lactamase-producing Klebsiella pneumoniae (ESBL-KP) was detected from May 1993 to June 1995. A total of 145 patients, particularly patients in intensive care units (ICUs) (107 patients [72%]), were colonized or infected. Infection developed in 92 (63%) patients, and primary bacteremia caused by ESBL-KP was the most frequent infection (40 of 92 patients [43%]). A single clone of ESBL-KP was identified by pulsed-field gel electrophoresis analysis throughout the whole period, and no molecular epidemiological relationship could be found between the epidemic strain and non-ESBL-KP isolates. To determine risk factors for ESBL-KP infection weekly rectal swabs were obtained in three serial incidence surveys (470 patients); the probabilities of carriage of ESBL-KP in the digestive tract were 33% (October and November 1993), 40% (May and June 1994), and 0% (October and November 1995) at 10 days of ICU admission. A logistic regression model identified prior carriage of ESBL-KP in the digestive tract (odds ratio, 3.4; 95% confidence interval 1.1 to 10.4) as an independent variable associated with ESBL-KP infection. A statistically significant correlation was observed between the restricted use of oxyimino-beta -lactams (189 defined daily doses [DDD]/1,000 patient-days to 24 DDD/1,000 patient-days) and the trends of ESBL-KP infection (r = 0.7; P = 0.03).

* Corresponding author. Mailing address: Infectious Disease Service, Hospital de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. Phone: 011-34-3-3359011, ext. 2488. Fax: 011-34-3-2633775. E-mail: mpujol{at}csv.scs.es.

Antimicrobial Agents and Chemotherapy, January 1998, p. 53-58, Vol. 42, No. 1
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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