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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

Monica Cartelle,1 Maria del Mar Tomas,1 Sonia Pertega,2 Alejandro Beceiro,1 M. Angeles Dominguez,3 David Velasco,1 Francisca Molina,1 Rosa Villanueva,1 and German Bou1*

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)

* Corresponding author. Mailing address: Servicio de Microbiologia, Complejo Hospitalario Juan Canalejo, C/As Xubias 84, 15006 La Coruña, Spain. Phone: 34-981-178000, ext. 21144. Fax: 34-981-178216. E-mail: germanbou{at}canalejo.org.

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.



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