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Objectives : to establish nursing assistance to a patient in contact isolation with Klebsiella spp. and diabetic ketoacidosis complications into Intensive Care Unit; to identify nursing diagnoses according to Lynda Juall Carpenito and to establish and to implement the nursing care plan. Methodology : study of case, carried through from May 19 th to June 4 th 2008. Data had been collected into clinical handbook and daily physical examination. After that, according nursing’s description, we identified health problems to elaborate nursing daily plan associated with nursing diagnoses by Lynda Juall Carpenito to guide nursing assistance. Results : data were presented by nursing’s description and in a figure, nursing diagnoses, results and nursing prescription - constituting nursing assistance plan. The following nursing diagnoses were identified: anxiety, integrity of harmed skin, social isolation, risk for infection, risk of infection transmission, risk for aspiration and risk for alteration of body temperature . Data were analyzed and discussed according to literature. Conclusion: nursing diagnoses offered the direction to nursing intervention: control diabetes another case of diabetic ketoacidosis and control Klebsiella spp. infection to the patient and transmission to other people. Descriptors : d iabetes mellitus; d iabetic ketoacidosis ; klebsiella spp. ; nursing diagnoses. RESUMO Objetivos : estabelecer a assistencia de enfermagem para uma paciente em isolamento de contato por Klebsiella spp . e com complicacoes do diabetes internada em uma Unidade de Terapia Intensiva; c lassificar os diagnosticos de enfermagem de acordo com Lynda Juall Carpenito; elaborar e implementar o plano de cuidados de enfermagem. Metodologia : estudo de caso, realizado no periodo de 19 de maio a 04 de junho de 2008. Os dados foram coletados a partir de consultas ao prontuario clinico e realizacao do exame fisico da paciente. A partir do historico de Enfermagem, foram identificados os problemas de saude da paciente, possibilitando a elaboracao do plano de cuidados com os diagnosticos de enfermagem de acordo com Lynda Juall Carpenito, que nos conduziu na assistencia de enfermagem. Resultados : os dados foram apresentados na forma de historico de Enfermagem e, em uma figura, os diagnosticos, resultados e prescricoes de enfermagem ¾ que se constituiu no plano de assistencia de enfermagem. Os diagnosticos identificados foram: ansiedade, integridade da pele prejudicada, isolamento social, risco para infeccao, risco para transmissao de infeccao, risco para aspiracao e risco para alteracao da temperatura corporal. Os dados foram analisados e discutidos com base na literatura disponivel. Consideracoes finais : os diagnosticos de Enfermagem identificados nos forneceram a direcao para as intervencoes de Enfermagem, com a finalidade de atingir os resultados esperados: o controle do D iabetes mellitus da paciente, evitando outro episodio de cetoacidose diabetica e o controle da infeccao da paciente por Klebsiella spp. bem como sua propagacao para outras pessoas. Descritores : d iabetes mellitus; cetoacidose diabetica; klebsiella spp. ; diagnostico de enfermagem. RESUMEN Objetivos : establecer los cuidados de enfermeria a un paciente en el aislamiento del contacto para la Klebsiella spp. y las complicaciones del cetoacidose diabetica en una Unidad de Cuidados Intensivos; identifican diagnostico de enfermeria segun Lynda Juall Carpenito y establecer y ejecutar el plan de los cuidados. Metodologia : estudio de caso, ejecutado en el periodo de 19 de mayo los 04 de junio de 2008. Los datos habian sido recogidos en el manual clinico y la examinacion fisica diaria del paciente. Despues de ese, acordando la descripcion de enfermeria, identificamos problemas de salud para elaborar plan diario de cuidado asociado a diagnostico de enfermeria por Lynda Juall Carpenito para dirigir el plan de cuidados de enfermeria. Resultados : los datos fueron presentados por la descripcion del plan de enfermeria y en una figura, los diagnosticos de enfermeria, resultados y la prescripcion del cuidados de enfermeria - constituyendo el cuidado de de enfermeria. Fueran identificados los seguientes diagnosticos de enfermeria: ansiedad, integridad de la piel danada, aislamiento social, riesgo para la infeccion, riesgo para la transmision de la infeccion, riesgo para la aspiracion y riesgo para la alteracion de la temperatura del cuerpo. Los datos fueran analizados y discutidos segun la literatura. Conclusion : los diagnosticos de enfermeria ofrecio la direccion a la intervencion de enfermeria: controlar la diabetes y otro caso de ketoacidosis diabetico aiun controlar la Klebsiella spp. infeccion al paciente y transmision a la otra gente. Descriptores : diabetes mellitus; cetoacidosis diabetica; k lebsiella ; diagnostico de enfermeria.

El trabajo tuvo como objetivo determinar el grado de contaminación por Enterobacterias en las carnes resultantes del sacrificio en un matadero tecnificado ("carnes y derivados de occidente") y en dos cuyas normas higiénicas no eran las recomendadas (Palmira y Florida) situados en el Departamento del valle del Cauca, República de Colombia. La evaluación bacteriológica comprendió el estado de las salas de sacrificio, el sistema de sacrificio y el faenado. Se tomaron en dos ocasiones muestras del brazo, costillar y pierna, la primera tan pronto se retiró la piel del animal (testigo) y la segunda cuando terminó el faenado de la carne. Las muestras se procesaron según los métodos estandarizados. El mayor aislamiento se logró en los mataderos de Palmira y Florida, en ellos se aislaron Escherichia coli y klebsiella spp. Los gérmenes aislados en "Carnes de Occidente" fueron en general contaminantes de poca incidencia patológica y propios de procedimiento de toma, envío y otros factores. The degree of Enterobacteria contamination in meats processed in a modem abbatoire (carnes y derivados de occidente) and in two others where hygiene was no strict was determined. The bacteriological evaluation was conducted in the slaughtering room s, and in the whole slaughtering and processing systems. Samples from front and back legs and from the ribs were take in two occasions; first as soon as the animal was skimed and then at the end or the cutting process. The samples were processed in the standard way. Both, at Palmira and Florida abbatories were Escherichia coli and klebsiella spp isolated. Bacteria isolated at "Carnes de Occidente "were low virulence contaminats and possibly present because of the techniques used in the sampling procedure.

This is the first report on the isolation of Klebsiella planticola from neonates. Over a period of 1 year, oropharyngeal and rectal swab specimens from 131 newborns on a neonatal ward were monitored for Klebsiella spp. Thirteen strains of K. planticola could be isolated, and these represented 9% of all Klebsiella spp. found. Capsule type K27 predominated, followed by capsule type K68. Our findings suggest a significant rate of colonization by K. planticola among neonates.

All of the febrile episodes occurring in 494 adults with acute leukemia were reviewed. There were an average of 2.39 febrile episodes per patient and the patients spent 28% of their days in the hospital with fever. Sixty-four percent of the febrile episodes were due to infection. The most common types of infection were disseminated infection and pneumonia, which together accounted for 69% of the total episodes of documented infection. The etiologic agent was identified in 73% of the documented infections and gram-negative bacilli were responsible for the great majority. The most common gram-negative bacilli causing infection were Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa. During the course of their leukemia, 31% of the patients had repeated episodes of infection caused by the same organism and 13% ahd repeated FUO's. Fever occurred most often when the patients had neutropenia (less than 500/mm3). The fatality rate from septicemia decreased from 84% in 1966 to 44% in 1972. The fatality rate for major infections caused by gram-positive cocci was 16%, for gram-negative bacilli was 37% and for fungi was 86%. Although infection remains a serious problem in leukemia patients, considerable progress has been made.

SUMMARYEpidemiological analysis ofKlebsiellastrains from nosocomial infections needs a simple, stable and reproducible technique of typing. We have evaluated three bacteriocin typing methods forKiebsiellaspp. by means of 15 bacteriocin-producing strains, with special reference to stability and reproducibility.With the three methods indicator strains and clinical strains were retyped on different days under constant test procedures. Stability of bacteriocins was tested by titration immediately after preparation and after 4 weeks of storage at –70°C. Thereafter, reproducibility of typing was tested by means of these freshly prepared bacteriocin lysates and of portions of the same lysates stored at –70 °C. A moderate reproducibility was obtained with one method after two typing experi ments: 79.2% and 61.3% for indicator strains and clinical strains respectively. The other two methods gave a much lower reproducibility of 38 .5% and 32.5 % for indicator strains and of 11.1% and 25.5% for clinical strains after two experiments.The reproducibility decreased after retyping three, four or five times. These methods are simple to perform but their usefulness for epidemiological studies is doubtful. Possible causes of the lack of reproducibility of the methods are discussed.

The die-off process of coliform group was investigated in AIT-oxidation ponds in parallel with the laboratory tests. More than 99% of coliform group was removed in AIT-oxidation ponds. A major type of coliform group in the influent was E. coli., while Klebsiella spp. took place of E. coli. in the effluent. E. coli. was more sensitive to the environmental conditions in AIT-oxidation ponds than Klebsiella spp. and C. freundii.The model for predicting the coliform group density in the facultative pond was proposed and the die-off rate coefficient was estimated. In case that a factor affecting the die-off process of coliform group was expressed by the sum of the sunlight effect, the dissolved oxygen effect and the pH effect, a better estimatin of the coliform group density was obtained. And then the estimated die-off rate coefficient was 2.56 (1/day) around 30°C.

Nosocomial infections of bacterial origin continue to be a leading cause of morbidity and mortality among virtually all hospitalized patient populations 1 . It is estimated that nearly 5% of all hospitalized individuals will acquire an infection during their stay 2 . Approximately 3% of nosocomial infections will contribute to an eventual fatal outcome 1 . Preeminent among nosocomial pathogens are the aerobic Gram-negative bacilli, with Escherichia coli, Pseudomonas aeruginosa and Klebsiella spp. being the causative agents for the majority of life-threatening infections 1–4 . This review describes the current situation and future prospects for combatting these infections.

SUMMARY The variation in metabolism of biochemical test substrates by klebsiella isolates has been demonstrated. It is suggested that this variation is likely to result in false-negative reactions in biochemical tests incubated for short periods. The observations made may explain the reported difficulties in obtaining reproducible results in biotyping Klebsiella strains. Preliminary work suggests that differences in substrate metabolism will provide a means of increasing the sensitivity of methods for the biochemical typing of Klebsiella spp.

OBJECTIVE: The Phene Plate (PhP) biochemical fingerprinting system is based on measurements of the kinetics of selected biochemical reactions performed in microtiter plates, and computerized data-processing. This study compared the performance of the PhP system as an epidemiologic tool with other commonly used typing systems. METHODS: PhP typing was applied to 107 nosocomial Klebsiella spp. isolates from 10 collections, mostly representing outbreaks. The results were compared with those obtained by capsular (K) serotyping, phage typing and, for a subset of isolates (n=33), pulsed-field gel electrophoresis (PFGE). RESULTS: Clusters of identical or closely related isolates based on serotype, phage type, PhP type and PFGE type were found in most collections. The typeability was 100%, 95%, 94% and 68% for PhP, K, PFGE and phage typing, respectively. The agreement between the typing methods was high (88-96%). The discriminatory power was high for PhP and PFGE (diversity index 0.95 and 0.97, respectively), but lower for phage typing (diversity index 0.91) and K typing (diversity index 0.87). CONCLUSIONS: Like serotyping and PFGE, PhP typing is useful in studies of the nosocomial epidemiology of Klebsiella spp. Combining PhP typing with PFGE or K typing rarely yielded additional information when comparing isolates within each collection, but PFGE sometimes discriminated between isolates of similar PhP type derived from different collections.

In a prospective study, twenty children with a mean age of 4 years were treated with pivmecillinam, 25 mg to 40 mg per kilogram body-weight and day, for acute pyelonephritis. Urine cultures yielded growth of E. coli in sixteen instances, Klebsiella spp. in two, S. saprophyticus in one and a mixed Gram-positive flora in one patient. All children fulfilled the diagnostic criteria for upper urinary tract infection. In all cases where Gram-negative pathogens were responsible, the infections were eradicated. One reinfection was registered in a child with a concomitantly discovered congenital urological malformation. Pivmecillinam also cured one patient infected with S. saprophyticus but was ineffective in the case of mixed Gram-positive flora. It is concluded that pivmecillinam is a valuable new drug for the management of pyelonephritis in children, as most of these infections are caused by Gram-negative organisms.

The use of the 4-methylumbelliferyl glucuronide (MUG) to differentiate between Escherichia coli and biotypes of Klebsiella pneumoniae isolated from beansprouts is described. The incorporation of MUG into the selective media ensured that the presence of Klebsiella spp. on the beansprouts was not confused with E. coli.

Seventeen per cent of the staff of an intensive care ward were found to have Klebsiella spp contaminating their hands, and these strains could be related to serotypes infecting or colonising patients in the ward on the same day. We identified some simple ward procedures that resulted in contamination of nurses' hands with 100-1000 klebsiellae per hand. Klebsiellae survived on artifically inoculated hands for up to 150 minutes. Handwashing with chlorhexidine hand cleanser reliably gave 98-100% reduction in hand counts, and the introduction of routine handwashing by staff before moving from one patient to the next was associated with a significant and sustained reduction in the number of patients colonised or infected with Klebsiella spp. Staff clothing was occasionally contaminated, but ward air and dust rarely contained klebsiellae.

We have evaluated claims that impaired peripheral blood lymphocyte (PBL) transformation can occur with Klebsiella spp. in patients with ankylosing spondylitis (AS). PBL of four AS patients were cultured in vitro with autogenous faecal klebsiella, as were the PBL of age (+/- 3 years) and sex-matched pairs of 15-20 AS and normal controls cultured with heterogeneous AS-derived klebsiella and control bacterial isolates. Three of four AS patients responded to their own isolates, and no significant differences were found between the matched pairs in response to heterogeneous klebsiella isolates, including K21. Our studies did not show impaired PBL transformation with klebsiella in AS and therefore do not support claims of antigenic cross-reactivity between klebsiella and HLA-B27.

Over a one-year period 239 patients with community-acquired bacteraemia were studied prospectively to evaluate their clinical profile, course and outcome. Gram-negative organisms accounted for 108 (45 per cent) episodes of bacteraemia, Gram-positive 121 (51 per cent) and polymicrobial 10 (4 per cent). The organisms isolated most commonly were E. coli (28.9 per cent), Klebsiella spp. (7.5 per cent), S. pneumoniae (21.3 per cent), S. aureus (12.1 per cent) and haemolytic streptococci (4.6 per cent). The overall mortality was 29.2 per cent and most deaths were caused by bacteraemia or related complications. This condition therefore still has a high mortality despite modern antimicrobial drugs and intensive care. The most important factor in reducing mortality is early recognition and administration of appropriate antimicrobial drugs.

In a multicentre study conducted by the Paul-Ehrlich-Gesellschaft we tested about 35,000 bacterial isolates from different hospitals in the Federal Republic of Germany, Berlin (West), Austria and Switzerland between 1975 and 1984. None of the bacterial species under test showed an increase in the number of resistant strains. A slight decrease in the percentage of resistant strains to some antibiotics was observed with Staphylococcus aureus; Klebsiella spp. showed a significant decrease in this respect. Because of this phenomenon and the introduction of new drugs, chemotherapy today is usually safer than ten years ago. However, in some places the amount of resistant strains was significantly different from the overall resistance. In comparison of these data with those from the U.S.A. (Atkinson & Lorian, 1984) no difference in an antibiotic-species pair exceeded 13%.

One hundred and six strains of Klebsiella spp were examined for their ability to produce bacteriocine. Nine of these, together with one strain from the National Collection of Type Cultures, were selected and used to type Klebsiella strains from various sources. Strains were typed by testing their sensitivity to bacteriocines produced by the standard set of 10 strains. Eight hundred strains were tested and 77% of these were typable and could be divided into a relatively large number of groups, some of which occurred consistently more frequently than others.This simple method has been shown to have some value in epidemiological investigations.

The presence of high numbers of Aeromonas spp. is undesirable in the water supply, as they may be potentially pathogenic. Furthermore, they have a strong food spoilage potential. Aeromomas spp. have also been found in chlorinated drinking water where coliform counts were low. The present study was conducted to examine the level of and variation in chlorine resistance of Aeromonas spp. Two methods were employed. Screening of relative chlorine resistance was done on 46 clinical and 41 environmental isolates of Aeromonas spp. at 30° C, using a disc assay with four concentrations of hypochlorite, and results were compared with those of E. coli (3), Ps. fluorescens (2), Klebsiella spp. (1), Ps. aeruginosa (1), and Acinetobacter (1). Resistance varied greatly between Aeromonas isolates, but they were in general more susceptible than the other bacteria tested. Inactivation studies were conducted following the survival of selected isolates in solutions of monochloramine (0, 0.5, 1.0, and 2.0 mg/l) over a period of 180 minutes at pH 7.0 and 10° C. The most resistant strain in the disc assay was also the most resistant in the inactivation study.

Background and objectives: Klebsiella species are of the most common bacteria involved in nosocomial and urinary tract infections. Genetic elements such as class 1 integrons have an important role in the resistance development. In this study, the share of class 1 integrons, the genetic characterization of the integron cassettes and PFGE profiles of the clinical Klebsiella isolates are evaluated in Besat University hospital of Sanandaj, Iran. Methods: Isolates from 17890 clinical specimens were identified by API20E. Antibiotic susceptibility testing and MIC were done for MDR isolates. For investigating class 1 integrons and gene cassettes, PCR by intI1 integrase and 5΄-CS/3΄-CS were performed. Integrated gene cassettes were analyzed by PCR-RFLP and sequencing. Pulsed-Field Gel Electrophoresis was carried out for studying of clonality outbreak of isolates. Results: Thirty five Klebsiella spp. were isolated and included 29 K. pneumoniae and six K. oxytoca. All the isolates were susceptible to carbapenems while other antibiotics showed high resistant profile. In all Klebsiella spp. PCR for intI1 integrase and 5΄-CS/3΄-CS were positive (100%). Sequencing for prevalent bands of internal variable regions between 5΄-CS/3΄-CS showed arr-5, orfD-aacA4 and aad5- dfrA17. PFGE Analysis showed 18 clusters in K. pneumoniae with clonality relatedness in some cases but no relatedness among K. oxytoca isolates. Conclusion: High prevalence of class 1 integron carrying gene cassettes confirms that integron-mediated antimicrobial gene cassettes are important in Klebsiella spp. resistance profile. Clone diffusions of MDR Klebsiella spp. which harbor class 1 integrons have threaten the potential in the resistance development in our clinical settings.

A highly selective, differential medium for the enumeration and isolation of Klebsiella spp. was developed. With pure cultures, 100% recovery of Klebsiella spp. was observed. Recovery of Klebsiella spp. on MacConkey-inositol-potassium tellurite (MCIK) agar was as good as or better than on MacConkey-inositol-carbenicillin agar either with pure cultures or environmental samples. Recovery and percent colony confirmation with MCIK agar were greater and easier to obtain than for other proposed Klebsiella selective media.

Differences in the delineation of Klebsiella spp. in the United Kingdom from that in the majority of other countries is discussed. An attempt is made to trace and interpret the reasons for these differences and suggestions are made for a rapid resolution of this problem which hazards communication.

Six media (mK2, mK4, mK5, mKleb, mFCIC, and mCIK) were assessed for their ability to recover Klebsiella spp. from nonpolluted and polluted waters. Ninety-six percent of presumptive target colonies recovered on mK2 were identified as Klebsiella spp., while approximately 93% of the presumptive target colonies on mFCIC, mKleb, mK4, and mK5 were identified as Klebsiella spp. Target colony identification on mCIK was difficult; therefore this medium was not considered for further testing. Performance characteristics were determined on mFCIC, mK2, and mK4 media in accordance with ASTM specifications. The false positive error for mK4 was 0.058, whereas the other media had values approximating 0.015. The mFCIC and mK5 media had an undetected target error of 0; the undetected target error for mKleb, mK2, and mK4 was less than 0.06. The index of selectivity for mKleb was 0.53, while the other media had an index of selectivity of approximately 0.64. Due to the low index of selectivity of mKleb, and the lower presumptive target colony recovery on mK5, these media were not considered for further evaluation. Accuracy values using unstressed Klebsiella cultures, for mFCIC, mK2, and mK4, averaged 114% compared to the reference mK medium base. Following the application of stress to the cultures for 24 h, the accuracy value calculated for mFCIC was 81.9% in comparison with values of 118.8% and 111.0% for mK2 and mK4, respectively. The upper counting limits for mK2, mFCIC, and mK4 were 115, 127, and 127 colonies per filter, respectively. Even though the performance characteristics of mK2, mK4 and mFCIC were similar, the medium judged most suitable for Klebsiella recovery was mK4. This was primarily due to the ease of identification of target colonies and the relatively low background colony interference.