Hostname: page-component-7479d7b7d-8zxtt Total loading time: 0 Render date: 2024-07-10T22:46:05.679Z Has data issue: false hasContentIssue false
  • English
  • Français

Evidence of Interhospital Transmission of Extended-Spectrum β-Lactam-Resistant Klebsiella pneumoniae in the United States, 1986 to 1993

Published online by Cambridge University Press:  02 January 2015

Dominique L. Monnet ,
James W. Biddle ,
Jonathan R. Edwards ,
David H. Culver ,
James S. Tolson ,
William J. Martone ,
Fred C. Tenover ,
Robert P. Gaynes  and
The National Nosocomial Infections Surveillance System
Dominique L. Monnet*
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
James W. Biddle
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Jonathan R. Edwards
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
David H. Culver
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
James S. Tolson
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
William J. Martone
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Fred C. Tenover
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Robert P. Gaynes
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Hospital Infections Program, MS E-55, Centers for Disease Control and Prevention, Atlanta, GA 30333
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

In addition to single-hospital outbreaks, interhospital transmission of extended-spectrum β-lactam-resistant (ESBLR) Klebsiella pneumoniae has been suspected in some reports. However, these studies lacked sufficient epidemiological information to confirm such an occurrence.

Methods:

We reviewed the surveillance data reported to the National Nosocomial Infections Surveillance (NNIS) System during 1986 to 1993 for K pneumoniae isolates and their susceptibility to either ceftazidime, cefotaxime, ceftriaxone, or aztreonam. Pulsed-field gel electrophoresis (PFGE) was used to study available ESBLR K pneumoniae isolates.

Results:

Among 8,319 K pneumoniae isolates associated with nosocomial infections, 727 (8.7%) were resistant or had intermediate-level resistance to at least one of these antibiotics. One hospital (hospital A) accounted for 321 isolates (44.2%) of ESBLR K pneumoniae. During 1986 to 1993, the percentage of K pneumoniae isolates that were ESBLR increased from 0 to 57.7% in hospital A, from 0 to 35.6% in NNIS hospitals 0 to 20 miles from hospital A (area B), and from 1.6 to 7.3% in NNIS hospitals more than 20 miles from hospital A, including hospitals located throughout the United States. Analysis of PFGE restriction profiles showed a genetic relationship between a cluster of isolates from hospital A and some isolates from one hospital in area B, and consecutive admission in these two hospitals was confirmed for two patients from whom isolates were available.

Conclusions:

These data provide evidence of interhospital transmission of ESBLR K pneumoniae in one region of the United States and stress the interrelationship between hospitals when trying to control antimicrobial resistance.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 7 , July 1997 , pp. 492 - 498
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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. Emori, TG, Gaynes, RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993;6:428–442.CrossRefGoogle ScholarPubMed
2. Weinstein, RA. Multiply drug-resistant pathogens: epidemiology and control. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 3rd ed. Boston, MA: Little, Brown & Co; 1992:265–288.Google Scholar
3. Jacoby, GA, Medeiros, AAA. More extended-spectrum β-lactamases. Antimicrob Agents Chemother 1991;35:1697–1704. Review.CrossRefGoogle ScholarPubMed
4. Meyer, KS, Urban, C, Eagan, JA, Berger, BJ, Rahal, JJ. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993;119:353–358.CrossRefGoogle ScholarPubMed
5. Naumovski, L, Quinn, JP, Miyashiro, D, et al. Outbreak of cef-tazidime resistance due to a novel extended-spectrum β-lactamase in isolates from cancer patients. Antimicrob Agents Chemother 1992;36:1991–1996.CrossRefGoogle ScholarPubMed
6. Rice, LB, Willey, SH, Papanicolaou, GA, et al. Outbreak of ceftazidime resistance caused by extended-spectrum β-lactamases at a Massachusetts chronic-care facility. Antimicrob Agents Chemother 1990;34:2193–2199.CrossRefGoogle Scholar
7. Thomson, KS, Cherubin, CE, Sanders, CC. Outbreak of extended-spectrum β-lactamase-producing Enterobacteriaceae associated with use of ceftazidime. In: Program and Abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy; 10 17-20, 1993; New Orleans, LA. American Society for Microbiology; 1993:233. Abstract.Google Scholar
8. Wiener, J, Quinn, J, Kowalczyk, M, Bush, K, Rasmussen, B, Weinstein, RA. Production of TEM-10 β-lactamase in ceftazidime-resistant (CFZ-R) Enterobacteriaceae from multiple nursing homes. In: Program and Abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy; 10 11-14, 1992; Anaheim, CA. American Society for Microbiology; 1992:217. Abstract.Google Scholar
9. Burwen, DR, Banerjee, SN, Gaynes, RP, the National Nosocomial Infections Surveillance System. Ceftazidime resistance among selected nosocomial gram-negative bacilli in the United States. J Infect Dis 1994;170:1622–1625.CrossRefGoogle ScholarPubMed
10. Brun-Buisson, C, Legrand, P, Philippon, A, Montravers, F, Ansquer, M, Duval, J. Transferable enzymatic resistance to third-generation cephalosporins during nosocomial outbreak of multi-resistant Klebsiella pneumoniae . Lancet 1987;ii:302–306.CrossRefGoogle Scholar
11. Jarlier, V, Nicolas, MH, Fournier, G, Philippon, A. Extended broad-spectrum β-lactamases conferring transferable resistance to newer p-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns. Rev Infect Dis 1988;10:867–878.CrossRefGoogle Scholar
12. Kitzis, MD, Billot-Klein, D, Goldstein, FW, et al. Dissemination of the novel plasmid-mediated β-lactamase CTX-1, which confers resistance to broad-spectrum cephalosporins, and its inhibition by β-lactamase inhibitors. Antimicrob Agents Chemother 1988;32:9–14.CrossRefGoogle ScholarPubMed
13. Sirot, J, Chanal, C, Petit, A, Sirot, D, Labia, R, Gerbaud, G. Klebsiella pneumoniae and other Enterobacteriaceae producing novel plasmid-mediated β-lactamases markedly active against third-generation cephalosporins: epidemiologic studies. Rev Infect Dis 1988;10:850–859.CrossRefGoogle ScholarPubMed
14. 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 β-lactamase. J Antimicrob Chemother 1987;20:323–334.CrossRefGoogle ScholarPubMed
15. Arlet, G, Rouveau, M, Casin, I, Bouvet, PJM, Lagrange, PH, Philippon, A. Molecular epidemiology of Klebsiella pneumoniae strains that produce SHV-4 β-lactamase and which were isolated in 14 French hospitals. J Clin Microbiol 1994;32:2553–2558.CrossRefGoogle ScholarPubMed
16. Sader, HS, Pfaller, MA, Jones, RN. Prevalence of important pathogens and the antimicrobial activity of parenteral drugs at numerous medical centers in the United States, II: study of the intra- and interlaboratory dissemination of extended-spectrum β-lactamase-producing Enterobacteriaceae . Diagn Microbiol Infect Dis 1994;20:203–208.CrossRefGoogle ScholarPubMed
17. Buré, A, Legrand, P, Arlet, G, Jarlier, V, Paul, G, Philippon, A. Dissemination in five French hospitals of Klebsiella pneumoniae serotype K25 harbouring a new transferable enzymatic resistance to third generation cephalosporins and aztreonam. Eur J Clin Microbiol Infect Dis 1988;7:780–782.CrossRefGoogle ScholarPubMed
18. Fernández-Rodríguez, A, Reguera, JA, Pérez-Diaz, JC, Picazo, JJ, Baquero, F. Primera epidemia española de resistencia plasmídica a cefalosporinas de tercera generación: implicación de SHV-2. Enferm Infecc Microbiol Clin 1992;10:456–460.Google ScholarPubMed
19. MacDonald, AA, Maple, PAC, Kibbler, CC, et al. Ceftazidime-resistant Klebsiella pneumoniae . Lancet 1991;337:1609–1610.CrossRefGoogle ScholarPubMed
20. Shannon, KP, King, A, Phillips, I, Nicolas, MH, Philippon, A. Importation of organisms producing broad-spectrum SHV-group β-lactamases into the United Kingdom. J Antimicrob Chemother 1990;25:343–351.CrossRefGoogle Scholar
21. Emori, TG, Culver, DH, Horan, TC, et al. National Nosocomial Infections Surveillance (NNIS) System: description of surveillance methods. Am J Infect Control 1991;19:19–35.CrossRefGoogle ScholarPubMed
22. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
23. SAS Procedures Guide, Version 6, 3rd ed. Cary, NC: SAS Institute Inc; 1990.Google Scholar
24. Snedecor, GW, Cochran, WG. Statistical Methods. 7th ed. Ames, IA: Iowa State University Press; 1980.Google Scholar
25. National Committee for Clinical Laboratory Standards. M7-A3. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. Approved standards. 3rd ed. Villanova, PA: NCCLS; 1993.Google Scholar
26. Levesque, RC, Medeiros, AA, Jacoby, GA. Molecular cloning and DNA homology of plasmid-mediated β-lactamase genes. Mol Gen Genet 1987;206:252–258.CrossRefGoogle ScholarPubMed
27. Flamm, RK, Phillips, KL, Tenover, FC, Plorde, JJ. A survey of clinical isolates of Enterobacteriaceae using a series of DNA probes for aminoglycoside resistance genes. Mol Cell Probes 1993;7:139–144.CrossRefGoogle ScholarPubMed
28. Bannerman, TL, Biddle, JW, Miller, JM. Optimization of pulsed-field gel electrophoretic (PFGE) method. J Clin Microbiol 1995;33:551–555.CrossRefGoogle Scholar
29. Tenover, FC, Arbeit, RD, Goering, RV, et al. Criteria for interpreting pulsed-field gel electrophoresis patterns. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle Scholar
30. Barrett, FF, McGehee, RF Jr, Finland, M. Methicillin-resistant Staphylococcus aureus at Boston City Hospital. Bacteriologic and epidemiologic observations. N Engl J Med 1968;279:441–448.CrossRefGoogle ScholarPubMed
31. El-Adhami, W, Roberts, L, Vickery, A, Inglis, B, Gibbs, A, Stewart, PR. Epidemiological analysis of a methicillin-resistant Staphylococcus aureus outbreak using restriction length polymorphisms of genomic DNA. J Gen Microbiol 1991;137:2713–2720.CrossRefGoogle ScholarPubMed
32. Haley, RW, Hightower, AW, Khabbaz, RF, et al. The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals. Ann Intern Med 1982;97:297–308.CrossRefGoogle ScholarPubMed
33. Humphreys, H, Carroll, JD, Keane, CT, Cafferkey, MT, Pomeroy, HM, Coleman, DC. Importation of methicillin-resistant Staphylococcus aureus from Baghdad to Dublin and subsequent nosocomial spread. J Hosp Infect 1990;15:127–135.CrossRefGoogle ScholarPubMed
34. O'Toole, RD, Drew, WL, Dahlgren, BJ, Beaty, HN. An outbreak of methicillin-resistant Staphylococcus aureus infection. Observations in hospital and nursing home. JAMA 1970;213:257–263.CrossRefGoogle ScholarPubMed
35. Rosdahl, VT, Knudsen, AM. The decline of methicillin resistance among Danish Staphylococcus aureus strains. Infect Control Hosp Epidemiol 1991;12:83–88.CrossRefGoogle ScholarPubMed
36. Saroglou, G, Cromer, M, Bisno, AL. Methicillin-resistant Staphylococcus aureus: interstate spread of nosocomial infections with emergence of gentamicin-methicillin-resistant strains. Infect Control 1980;1:81–89.CrossRefGoogle ScholarPubMed
37. Shanson, DC, Kensit, JG, Duke, R. Outbreak of hospital infection with a strain of Staphylococcus aureus resistant to gentamicin and methicillin. Lancet 1976;ii:1347–1348.CrossRefGoogle Scholar
38. Speller, DCE, Raghunath, D, Stephens, M, et al. Epidemic infection by a gentamicin-resistant Staphylococcus aureus in three hospitals. Lancet 1976;i:464–466.CrossRefGoogle Scholar
39. Strausbaugh, LJ, Jacobson, C, Yost, T. Methicillin-resistant Staphylococcus aureus in a nursing home and affiliated hospital: a four-year perspective. Infect Control Hosp Epidemiol 1993;14:331–336.Google Scholar
40. Ward, TT, Winn, RE, Hartstein, AI, Sewell, DL. Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: role of antimicrobial therapy in infection control. Infect Control 1981;2:453–459.CrossRefGoogle Scholar
41. Frieden, TR, Munsiff, SS, Low, DE, et al. Emergence of vancomycin-resistant enterococci in New York City. Lancet 1993;342:76–79.CrossRefGoogle ScholarPubMed
42. Murray, BE, Lopardo, HA, Rubeglio, EA, Frosolono, M, Singh, KV. Intrahospital spread of a single gentamicin-resistant, β-lactamase-producing strain of Enterococcus faecalis in Argentina. Antimicrob Agents Chemother 1992;36:2302–2304.CrossRefGoogle ScholarPubMed
43. Zervos, MJ, Kauffman, CA, Therasse, PM, Bergman, AG, Mikesell, TS, Schaberg, DR. Nosocomial infection by gentamicin-resistant Streptococcus faecalis . Ann Intern Med 1987;106:687–691.CrossRefGoogle ScholarPubMed
44. Zervos, MJ, Terpenning, MS, Schaberg, DR, Therasse, PM, Medendorp, SV, Kauffman, CA. High-level aminoglycoside-resistant enterococci. Colonization of nursing home and acute care hospital patients. Arch Intern Med 1987;147:1591–1594.CrossRefGoogle ScholarPubMed
45. Clabots, CR, Johnson, S, Olson, MM, Peterson, LR, Gerding, DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 1992;166:561–567.CrossRefGoogle ScholarPubMed
46. Schaberg, DR, Alford, RH, Anderson, R, Farmer, JJ III, Melly, MA, Schaffner, W. An outbreak of nosocomial infection due to multiply resistant Serratia marcescens: evidence of interhospital spread. J Infect Dis 1976;134:181–188.CrossRefGoogle ScholarPubMed
47. Katsanis, GP, Spargo, J, Ferraro, MJ, Sutton, L, Jacoby, GA. Detection of Klebsiella pneumoniae and Escherichia coli strains producing extended-spectrum β-lactamases. J Clin Microbiol 1994;32:691–696.CrossRefGoogle ScholarPubMed
48. Thomson, KS, Sanders, CC. Detection of extended-spectrum β-lactamases in members of the family Enterobacteriaceae: comparison of the double-disk and three-dimensional test. Antimicrob Agents Chemother 1992;36:1877–1882.CrossRefGoogle Scholar
49. Muder, RR, Brennen, C, Wagener, MM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.CrossRefGoogle ScholarPubMed
50. Jordens, JZ, Bates, J, Griffiths, DT. Molecular epidemiology of an outbreak with vancomycin-resistant enterococci. In: Abstracts of the 93rd general meeting of the American Society for Microbiology; 05 16-20, 1993; Atlanta, GA: American Society for Microbiology; 1993:C-252. Abstract.Google Scholar
51. Boyce, JM, Jackson, MM, Pugliese, G, et al. Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol 1994;15:105–115.CrossRefGoogle ScholarPubMed
52. Working Party Report. Revised guidelines for the control of epidemic methicillin-resistant Staphylococcus aureus . J Hosp Infect 1990;16:351–377.CrossRefGoogle Scholar
53. Hospital Infection Control Practices Advisory Committee (HICPAC). Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995;16:105–113.CrossRefGoogle Scholar