This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints and Permissions Copyright Information Books from ASM Press MicrobeWorld Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cartelle, M. Articles by Bou, G. Search for Related Content PubMed PubMed Citation Articles by Cartelle, M. Articles by Bou, G.

 Previous Article  |  Next Article 

Journal of Clinical Microbiology, September 2004, p. 4242-4249, Vol. 42, No. 9
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.9.4242-4249.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Risk Factors for Colonization and Infection in a Hospital Outbreak Caused by a Strain of Klebsiella pneumoniae with Reduced Susceptibility to Expanded-Spectrum Cephalosporins

Servicio de Microbiología,¹ Unidad de Epidemiologia Clinica, Complejo Hospitalario, Universitario Juan Canalejo, La Coruña,² Servicio de Microbiología, Hospital de Bellvitge, Barcelona, Spain³

Received 24 December 2003/ Returned for modification 4 April 2004/ Accepted 29 April 2004

Between February 2001 and January 2002, an increase in the number of Klebsiella pneumoniae isolates with reduced susceptibility to expanded-spectrum cephalosporins (RSKp) was detected in the neonatal unit of the Juan Canalejo Hospital, and 21 patients were either colonized or infected by the bacterial isolates. The current "gold standard" method for typing K. pneumoniae isolates is pulsed-field gel electrophoresis. However, this technique is expensive and time-consuming. In a search for faster and accurate alternatives to this method, we investigated PCR-based fingerprinting techniques (enterobacterial repetitive intergenic consensus sequence PCR [ERIC-PCR], repetitive extragenic palindromic sequence-based PCR [REP-PCR], and RAPD [randomly amplified polymorphic DNA]) for their ability to characterize K. pneumoniae isolates. The causal agent of the nosocomial outbreak was characterized by these techniques and was found to be a single epidemic strain (RSKp). A multiple regression logistic model was developed to identify potential independent factors associated with colonization and/or infection by RSKp. Logistic regression analysis was applied to all significant variables (P < 0.05) in the univariate analysis, and it was revealed that intubation (odds ratio [OR], 27.0; 95% confidence interval [95%CI], 5.39 to 135.14) and prematurity (OR, 4.4; 95%CI, 0.89 to 21.89) were such independent factors. Moreover, oxime cephalosporins did not appear to be statistically significant. Overall, the results showed that PCR-based techniques are expeditious and useful methods for typing K. pneumoniae isolates. Of the techniques studied, ERIC-PCR showed the highest discriminatory index (D = 0.828), followed by RAPD (D = 0.826) and REP-PCR (D = 0.773)

This article has been cited by other articles:

• Lincopan, N., Leis, R., Vianello, M. A., de Araujo, M. R. E., Ruiz, A. S., Mamizuka, E. M. (2006). Enterobacteria producing extended-spectrum {beta}-lactamases and IMP-1 metallo-{beta}-lactamases isolated from Brazilian hospitals.. J Med Microbiol 55: 1611-1613 [Full Text]  
• Tumbarello, M., Spanu, T., Sanguinetti, M., Citton, R., Montuori, E., Leone, F., Fadda, G., Cauda, R. (2006). Bloodstream Infections Caused by Extended-Spectrum-{beta}-Lactamase-Producing Klebsiella pneumoniae: Risk Factors, Molecular Epidemiology, and Clinical Outcome. Antimicrob. Agents Chemother. 50: 498-504 [Abstract] [Full Text]