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An Outbreak of Gentamicin-Resistant Klebsiella pneumoniae: Analysis of Control Measures

  • Louis D. Saravolatz (a1) (a2), Lucille Arking (a1) (a2), Donald Pohlod (a1) (a2), Evelyn J. Fisher (a1) (a2) and Robert Borer (a1) (a2)...


In April 1978, a strain of gentamicin-resistant Klebsiella pneumoniae (GRK) was introduced into the neonatal intensive care unit of Henry Ford Hospital. An additional ten cases of GRK occurred over the subsequent 16 months and intestinal colonization occurred in up to 91% of admissions per month. All GRK were susceptible to amikacin and were capsular serotype 19. Though hand contamination of hospital personnel with GRK was documented, increased handwashing practices did not reduce colonization rates of neonates with the epidemic strain. Intestinal carriage persisted for up to ten months and could not be eradicated by administering oral colistin sulfate. Discontinuation of gentamicin and utilization of amikacin were associated with a significant reduction in colonization with GRK (p < 0.05). However, the only control measure that prevented both new cases and colonization with the epidemic strain was the utilization of a strict cohort system.


Corresponding author

Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI 48202


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1.Allen, JR, Oliver, TK, The newborn nursery, in Bennett, JV, Brachman, PS (eds): Hospital Infections. Boston, Little Brown & Company, 1979, pp 104115.
2.Adler, JL, Shulman, JA, Terry, PM, et al: Nosocomial colonization with kanamycin-resistant Klebsiella pneumoniae, types 2 and 11, in a premature nursery. J Pediatr 1970;77:376385.
3.Hable, KA, Matsen, JM, Wheeler, DJ, et al: Klebsiella type 33 septicemia in an infant intensive care unit. J Pediatr 1972;80:920924.
4.Eisenach, KD, Reber, RM, Eitzman, DV, et al: Nosocomial infections due to kanamycin-resistant, (R)-factor carrying enteric organisms in an intensive care nursery. Pediatrics 1972;50:395402.
5.Hill, HR, Hunt, CE, Matsen, JM, Nosocomial colonization with Kleb-siella, type 26, in a neonatal intensive care unit associated with an outbreak of sepsis, meningitis and necrotizing enterocolitis. J Pediatr 1974;85:415419.
6.Crosson, FJ, Moxon, ER, Factors influencing kanamycin-resistance in gram-negative enteric neonatal sepsis. Pediatrics 1978;61:488489.
7.Eidelman, AL, Reynolds, J, Gentamicin-resistant Klebsiella infections in a neonatal intensive care unit. Am J Dis Child 1978;132:421422.
8.Mayhall, CG, Lamb, VA, Bitar, CM, et al: Nosocomial Klebsiella infection in a neonatal unit: Identification of risk factors in gastrointestinal colonization. Infect Control 1980;1:239246.
9.Wenzel, RP, Osterman, CA, Hunting, KJ, et al: Hospital-acquired infections. I. Surveillance in a university hospital. Am J Epidemiol 1976;103:251260.
10.Wenzel, RP, Osterman, CA, Hunting, KJ, Hospital-acquired infections. II. Infection rates by site, service and common procedures in a university hospital. Am J Epidemiol 1976;104:645651.
11.National Committee for Clinical Laboratory Standards Subcommittee on Antimicrobial Susceptibility Testing. Performance Standards for Antimicrobial Disc Susceptibility Tests. Villanova, Pennsylvania, National Committee for Clinical Laboratory Standards, 1975.
12.Washington, JA, Sutter, VL, Dilution susceptibility test: Agar and macro-broth dilution procedures, in Lennette, EH, Balows, A, Housler, WJ, et al (eds): Manual of Clinical Microbiology. Washington, DC, American Society for Microbiology, 1980, pp 453458.
13.Steers, E, Foltz, EL, Graves, BS, An inoculum replicating apparatus for routine testing of bacterial susceptibility to antibiotics. Antibiot Chemother 1959;9:307311.
14.Beneveniste, R, Davies, J, R-factor mediated gentamicin resistance. A new enzyme which modifies aminoglycoside antibiotics. FEBS Lett 1971;14:293.
15.Price, KE, DeFuria, MD, Pursiano, TA, Amikacin, an aminoglycoside with marked activity against antibiotic-resistant clinical isolates. J Infect Dis 1976;134:S249.
16.Davies, J, Courvalin, P, Mechanisms of resistance to aminoglycosides. Am J Med 1977;9:2529.
17.Montgomerie, JZ, Epidemiology of klebsiella and hospital-associated infection. Rev Infect Dis 1979;1:736753.
18.Goldmann, DA, Bacterial colonization and infection in the neonate. Am J Med 1981;70:417422.
19.Casewell, M, Phillips, I, Hands as a route of transmission for klebsiella species. Br Med J 1977;2:13151317.
20.Damato, JJ, Eitzman, DV, Baer, H, Persistence and dissemination in the community of R-factors of nosocomial origin. J Infect Dis 1974;129:205209.
21.Sande, MA, Mandeli, GL, Antimicrobial agents, in Goodman, LS, Gilman, A (eds): The Pharmacological Basis of Therapeutics. New York, MacMillan Publishing Co, 1980, pp 12221248.

An Outbreak of Gentamicin-Resistant Klebsiella pneumoniae: Analysis of Control Measures

  • Louis D. Saravolatz (a1) (a2), Lucille Arking (a1) (a2), Donald Pohlod (a1) (a2), Evelyn J. Fisher (a1) (a2) and Robert Borer (a1) (a2)...


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