engleski

Clonal spread of CTX-M producing Klebsiella pneumoniae in a Croatian Hospital

Background - Management of infections caused by Gram-negative ß-lactam resistant organisms is an increasing and challenging clinical problem. Wide distribution of Enterobacteriaceae resistant to ß-lactam and non-ß–lactam antibiotics, considerably reduce treatment options. Carbapenems have become antibiotics of a choice for therapy of nosocomial infections by ESBL producing strains. Being a frequent cause of hospital-based outbreaks, prompt laboratory detection and characterization is of great importance. Objectives - The aim of this study was to characterize Klebsiella pneumoniae extended-spectrum beta-lactamases (ESBLs) isolates among nosocomial Klebsiella pneumonia strains received from General Hospital Pula for routine diagnosis in year 2007. Methods - ESBL strain confirmations were conducted by phenotypic techniques: double disc-synergy test and ESBL-E-test. Degree of genetic heterogeneity was analyzed by pulsed field gel electrophoresis (PFGE) fingerprinting. Results - Klebsiella pneumoniae (ESBL) was isolated from 163 samples and accounted for 60.4 % of all Klebsiella pneumoniae isolates. Average age of the patients was 64.5 years (range 16-95). Most isolates originate from urine samples 100 (61.3%), followed by haemocultures 22 (13.5%), wound swabs 21 (12.9 %), tracheal aspirates 8 (4.9%), central vascular catheters 6 (3.7%), intra-abdominal abscess aspirates 5 (3.1%) and cerebrospinal fluid 1 (0.6%). The isolates originate from patients hospitalized at internal medicine department 74 (45.4%), followed by surgical intensive care 34 (20.9%), surgery 28 (17.2%), department of infectious diseases 16 (9.8%) and neurology 10 (6.1%). All isolates were susceptible to meropenem, imipenem, and amikacyn ; while resistant to other tested antibiotics. PFGE genotype analysis revealed six pattern types with an 80% similarity. Conclusion - Regular evaluation of isolates characteristics, monitoring the spread of the more virulent isolates within inpatient population is essential for timely identification and efficient management of nosocomial outbreaks. All patients were treated with meropenem. Heightened infection control measures and discouraged use of third-generation cephalosporin antibiotics lead to an effective control of the outbreak, that ceased by the end of the year 2007

Klebsiella pneumoniae; CTX-M-15 beta-lactamase; cefotaxime

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