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A hospital outbreak of extended-spectrum β-lactamase-producing Klebsiella pneumoniae investigated by RAPD typing and analysis of the genetics and mechanisms of resistance

Authors :
Kevin Shannon
Eddie G. M. Power
P.D. Stapleton
Gary French
K. Fung
Richard M. Anthony
Source :
Journal of Hospital Infection. 39:291-300
Publication Year :
1998
Publisher :
Elsevier BV, 1998.

Abstract

Between July and September 1997 a ceftazidime- and aminoglycoside-resistant strain of Klebsiella pneumoniae infected or colonized seven patients on three paediatric wards at Guy's Hospital in London. The patients were mostly neonates or infants recovering from cardiac surgery for congenital defects. The organism was probably introduced by an asymptomatic patient from Greece and the subsequent outbreak could largely be explained by person-to-person spread on individual wards and frequent transfers of patients between wards. The outbreak was controlled by patient isolation and attention to handwashing, and there were no fatalities. The organisms were non-typeable by serology but had a characteristic RAPD profile. They produced the extended-spectrum β-lactamase SHV-5 and the aminoglycoside-modifying enzymes AAC(6′) + probably AAC(3)II, encoded on a conjugative plasmid of approximately 160 kb. Two other patients had multi-resistant klebsiellas, one of them an SHV-5 producer and one a TEM-5 producer, but these could be distinguished from each other and from the outbreak strain by serological and RAPD typing and by the genetics and mechanisms of their resistances. Three other multi-resistant enterobacteria were isolated during the outbreak: an Escherichia coli that had acquired the 160 kb resistance plasmid from the epidemic klebsiella, a Citrobacter isolated from one of the patients with the klebsiella but which did not produce SHV-5, and a TEM-5-producing Enterobacter . This outbreak illustrates the importance of screening patients from high-risk areas for multiply-resistant organisms on admission, and the value of bacterial typing and analysis of resistance mechanisms to define the epidemiology of hospital infection.

Details

ISSN :
01956701
Volume :
39
Database :
OpenAIRE
Journal :
Journal of Hospital Infection
Accession number :
edsair.doi.dedup.....8da406c0698df1a22bb3b5399c8f3981
Full Text :
https://doi.org/10.1016/s0195-6701(98)90294-8