Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-19T06:34:11.868Z Has data issue: false hasContentIssue false
  • English
  • Français

Extended-Spectrum β-Lactamase–Producing Escherichia coli and Klebsiella Species: Risk Factors for Colonization and Impact of Antimicrobial Formulary Interventions on Colonization Prevalence

Published online by Cambridge University Press:  02 January 2015

Gregory Bisson ,
Neil O. Fishman ,
Jean Baldus Patel ,
Paul H. Edelstein  and
Ebbing Lautenbach
Gregory Bisson
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Neil O. Fishman
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Jean Baldus Patel
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Paul H. Edelstein
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Ebbing Lautenbach*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, the Center for Clinical Epidemiology and Biostatistics, and theUniversity of Pennsylvania Center for Education and Research on Therapeutics (CERTs), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
*
University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The incidence of extended-spectrum β-lactamase (ESβL)–mediated resistance has increased markedly during the past decade. Risk factors for colonization with ESβL-producing Escherichia coli and Klebsiella species (ESβL-EK) remain unclear, as do methods to control their further emergence.

Design:

Case–control study.

Setting:

Two hospitals within a large academic health system: a 725-bed academic tertiary-care medical center and a 344-bed urban community hospital.

Patients:

Thirteen patients with ESβL-EK fecal colonization were compared with 46 randomly selected noncolonized controls.

Results:

Duration of hospitalization was the only independent risk factor for ESβL-EK colonization (odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21). Of note, 8 (62%) of the patients had been admitted from another healthcare facility. In addition, there was evidence for dissemination of a single K. oxytoca clone. Finally, the prevalence of ESβL-EK colonization decreased from 7.9% to 5.7% following restriction of third-generation cephalosporins (P = .51).

Conclusions:

ESβL-EK colonization was associated only with duration of hospitalization and there was no significant reduction following antimicrobial formulary interventions. The evidence for nosocomial spread and the high percentage of patients with ESβL-EK admitted from other sites suggest that greater emphasis must be placed on controlling the spread of such organisms within and between institutions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 5 , May 2002 , pp. 254 - 260
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Jacoby, GA. Extended-spectrum β-lactamases and other enzymes providing resistance to oxyimino-β-lactams. Infect Dis Clin North Am 1997;11:875–887.Google Scholar
2.Jacobson, KL, Cohen, SH, Inciardi, JF, et al. The relationship between antecedent antibiotic use and resistance to extended-spectrum cephalosporins in group I B-lactamase-producing organisms. Clin Infect Dis 1995;21:1107–1113.Google Scholar
3.Rice, LB, Eckstein, EC, DeVente, J, et al. Ceftazidime-resistant Klebsiella pneumoniae isolates recovered at the Cleveland Department of Veterans Affairs Medical Center. Clin Infect Dis 1996;23:118–124.Google Scholar
4.Schiappa, DA, Hayden, MK, Matushek, MG, et al. Ceftazidime-resistant Klebsiella pneumoniae and Escherichia coli bloodstream infection: a case-control and molecular epidemiologic investigation. J Infect Dis 1996;174:529–536.Google Scholar
5.Knothe, H, Shah, P, Kremery, V, et al. Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection 1983;11:315–317.Google Scholar
6.Sirot, D, Sirot, J, Labia, R, et al. Transferable resistance to third-generation cephalosporins in clinical isolates of Klebsiella pneumoniae: identification of CTX-1, a novel B-lactamase. J Antimicrob Chemother 1987;20:323–334.CrossRefGoogle Scholar
7.Brun-Buisson, C, Legrand, P, Phillippon, A, et al. Transferable enzymatic resistance to third-generation cephalosporins during nosocomial outbreak of multiresistant Klebsiella pneumoniae. Lancet 1987;2:302–306.CrossRefGoogle ScholarPubMed
8.Rice, LB, Willey, SH, Papanicolaou, GA, et al. Outbreak of ceftazidime resistance caused by extended-spectrum B-lactamases at a Massachusetts chronic-care facility. Antimicrob Agents Chemother 1990;34:2200–2209.CrossRefGoogle Scholar
9.Meyer, KS, Urban, C, Eagen, JA, et al. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993;119:353–358.Google Scholar
10.Itokazu, GS, Quinn, JP, Bell-Dixon, C, et al. Antimicrobial resistance rates among aerobic gram-negative bacilli recovered from patients in intensive care units: evaluation of a national postmarketing surveillance program. Clin Infect Dis 1996;23:779–784.Google Scholar
11.Lautenbach, E, Patel, JB, Bilker, WB, et al. Extended-spectrum B-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;15:1162–1171.Google Scholar
12.Paterson, DL, Ko, WC, Mohapatra, S, et al. Klebsiella pneumoniae bacteremia: impact of extended-spectrum B-lactamase (ESBL) production in a global study of 216 patients. Presented at the annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy; September 28-October 1, 1997; Toronto, Ontario, Canada.Google Scholar
13.Wiener, J, Quinn, JP, Bradford, PA, et al. Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999;281:517–523.Google Scholar
14.Lucet, JC, Chevret, S, Decre, D, et al. Outbreak of multiply resistant enterobacteriaceae in an intensive care unit: epidemiology and risk factors for acquisition. Clin Infect Dis 1996;22:430–436.Google Scholar
15.Knaus, WA, Drapier, EA, Wagner, DP, et al. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.Google Scholar
16.National Committee for Clinical Laboratory Standards (NCCLS). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically, 5th ed. Approved standard. M7-A5. Wayne, PA: National Committee for Clinical Laboratory Standards; 2000.Google Scholar
17.Thomson, KS, Sanders, CC. Detection of extended-spectrum beta-lacta-mases in members of the family enterobacteriaceae: comparison of the double-disk and three-dimensional tests. J Clin Microbiol 1992;36:1877–1882.Google Scholar
18.Livermore, DM, Williams, JD. B-lactams: mode of action and mechanisms of bacterial resistance. In: Lorian, V, ed. Antibiotics in Laboratory Medicine, 4th ed. Baltimore, MD: Williams and Wilkins; 1996.Google Scholar
19.Gautom, RK. Rapid pulsed-field gel electrophoresis protocol for typing of Escherichia coli 0157:H7 and other gram-negative organisms in 1 day. J Clin Microbiol 1997;35:2977–2980.Google Scholar
20.Kleinbaum, DG, Kupper, LL, Morgenstern, H. Epidemiologic Research: Principles and Quantitative Methods. New York: Van Nostrand Reinhold; 1982.Google Scholar
21.Mantel, N, Haenszel, W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719–748.Google Scholar
22.Hosmer, DW, Lemeshow, S. Applied Logistic Regression. New York: John Wiley & Sons; 1989.Google Scholar
23.Piroth, L, Aube, H, Doise, JM, et al. Spread of extended-spectrum β-lactamase-producing Klebsiella pneumoniae: are β-lactamase inhibitors of therapeutic value? Clin Infect Dis 1998;27:76–80.Google Scholar
24.Pena, C, Pujol, M, Ardanuy, C, et al. Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended-spectrum β-lactamases. Antimicrob Agents Chemother 1998;42:53–58.Google Scholar
25.DeChamps, C, Sauvant, MP, Chanal, C, et al. Prospective survey of colonization of infection caused by expanded-spectrum B-lactamase-producing members of the family enterobacteriaceae in an intensive care unit. J Clin Microbiol 1989;27:2887–2890.Google Scholar
26.Pena, C, Pujol, M, Ricart, A, et al. Risk factors for faecal carriage of Klebsiella pneumoniae producing extended spectrum β-lactamase (ESBL-KP) in the intensive care unit. J Hosp Infect 1997;35:9–16.Google Scholar
27.Deere, D, Gachot, B, Lucet, JC, et al. Clinical and bactériologie epidemiology of extended-spectrum B-lactamase-producing strains of Klebsiella pneumoniae in a medical intensive care unit. Clin Infect Dis 1998;27:834–844.Google Scholar
28.Casewell, M, Philipps, I. Hands as route of transmission for Klebsiella species. Br Med J 1977;2:1315–1317.Google Scholar
29.D'Agata, E, Venkataraman, L, DeGirolami, P, et al. The molecular and clinical epidemiology of enterobacteriaceae producing extended-spectrum β-lactamase in a tertiary care hospital. J Hosp Infect 1998;36:279–285.Google Scholar
30.Lucet, JC, Fichelle, A, Decre, D, et al. Control of a prolonged outbreak of extended-spectrum B-lactamase-producing Enterobacteriaceae in a university hospital. Presented at the American Society for Microbiology 36th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; September 15-18, 1996; New Orleans, LA. Abstract no. J108.Google Scholar