David L. Paterson, MBBS, FRACP; Wen-Chien Ko, MD; Anne Von Gottberg, MBChB; Sunita Mohapatra, MD; Jose Maria Casellas, MBBS; Herman Goossens, MD; Lutfiye Mulazimoglu, MD; Gordon Trenholme, MD; Keith P. Klugman, MBChB; Robert A. Bonomo, MD; Louis B. Rice, MD; Marilyn M. Wagener, MPH; Joseph G. McCormack, MD, FRACP; Victor L. Yu, MD
Acknowledgments: The authors thank the staff and patients of the following hospitals for their participation: Pittsburgh Veterans Affairs Medical Center, Pittsburgh, and Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois; National Cheng Kung University Medical College, Tainan, Taiwan; Royal Brisbane Hospital, Mater Adults Hospital, and Greenslopes Private Hospital, Brisbane, Queensland, Australia; Hillbrow Hospital and Chris Hani Baragwanath Hospital, Johannesburg, South Africa; Marmara University Hospital, Istanbul, Turkey; University Hospital, Antwerp, Belgium; and San Lucas Hospital and Comunidad Olivos Hospital, Buenos Aires, Argentina.
Grant Support: By the Cottrell Fellowship of the Royal Australasian College of Physicians, Wyeth-Ayerst Pharmaceuticals, and Merck and Company.
Potential Financial Conflicts of Interest:Consultancies: D.L. Paterson (Cubist Pharmaceuticals, AstraZeneca, Merck), K.P. Klugman (Abbott Laboratories, AstraZeneca, Bayer Corp., GlaxoSmithKline Pharmaceuticals), L.B. Rice (Elan, Wyeth, Merck, AstraZeneca, Bristol-Myers Squibb, Ortho-McNeil); Honoraria: D.L. Paterson (Wyeth, Merck, AstraZeneca, Pfizer, Gilead), H. Goossens (Merck), K.P. Klugman (Abbott Laboratories, AstraZeneca, Bayer Corp., GlaxoSmithKline Pharmaceuticals), L.B. Rice (Elan, Wyeth, Merck, Ortho-McNeil); Expert testimony: L.B. Rice (Wyeth); Grants received or pending: D.L. Paterson (Elan, Pharmacia, Merck, AstraZeneca, Dade Microscan, Pfizer, Ortho-McNeil, Bristol-Myers Squibb), H. Goossens (Merck), K.P. Klugman (Abbott Laboratories, Bayer Corp., Bristol-Myers Squibb Co., GlaxoSmithKline Pharmaceuticals), R.A. Bonomo (AstraZeneca, Wyeth Pharmaceuticals, Bristol-Myers Squibb), L.B. Rice (Ortho-McNeil, Elan, Wyeth).
Requests for Single Reprints: Victor L. Yu, MD, Infectious Disease Section, Veterans Affairs Medical Center, University Drive C, Pittsburgh, PA 15240; e-mail, email@example.com.
Current Author Addresses: Dr. Paterson: Division of Infectious Diseases, University of Pittsburgh Medical Center, 3601 Fifth Avenue, Pittsburgh, PA 15213.
Dr. Ko: National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan, Taiwan.
Dr. Von Gottberg: NHLS, Corner De Korte and Hospital Streets, Johannesburg 2000, Republic of South Africa.
Drs. Mohapatra and Trenholme: Section of Infection Diseases, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois.
Dr. Casellas: Centro de Estudias en Antimicrobianos, Triunvirato 2789, Buenos Aires, Argentina.
Dr. Goossens: Department of Microbiology, University Hospital, Antwerp, Belgium.
Dr. Mulazimoglu: Department of Microbiology, Marmara University, Istanbul, Turkey.
Dr. Klugman: Emory University, 1518 Clifton Road, Atlanta, GA 30322.
Drs. Bonomo and Rice: Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106.
Ms. Wagener: University of Pittsburgh, Pittsburgh, PA 15240.
Dr. McCormack: University of Queensland Department of Medicine, Mater Adults Hospital, Brisbane, Queensland 4101, Australia.
Dr. Yu: Infectious Disease Section, Veterans Affairs Medical Center, University Drive C, Pittsburgh, PA 15240.
Author Contributions: Conception and design: D.L. Paterson, K.P. Klugman, J.G. McCormack, V.L. Yu.
Analysis and interpretation of the data: D.L. Paterson, A. Von Gottberg, K.P. Klugman, L.B. Rice, M.M. Wagener, V.L. Yu.
Drafting of the article: D.L. Paterson, A. Von Gottberg, J.G. McCormack, V.L. Yu.
Critical revision of the article for important intellectual content: D.L. Paterson, J.M. Casellas, K.P. Klugman, L.B. Rice, J.G. McCormack.
Final approval of the article: D.L. Paterson, A. Von Gottberg, H. Goossens, K.P. Klugman, L.B. Rice, M.M. Wagener, J.G. McCormack, V.L. Yu.
Provision of study materials or patients: W.-C. Ko, A. Von Gottberg, S. Mohapatra, H. Goossens, G. Trenholme, K.P. Klugman, V.L. Yu.
Statistical expertise: M.M. Wagener.
Obtaining of funding: V.L. Yu.
Administrative, technical, or logistic support: A. Von Gottberg, R.A. Bonomo.
Collection and assembly of data: D.L. Paterson, W.-C. Ko, A. Von Gottberg.
Commonly encountered nosocomially acquired gram-negative bacteria, especially Klebsiella pneumoniae, produce extended-spectrum β-lactamases (ESBLs) as an antibiotic resistance mechanism.
To determine whether microbiology laboratories should report the presence of ESBLs and to establish the infection-control implications of ESBL-producing organisms.
Prospective observational study.
12 hospitals in South Africa, Taiwan, Australia, Argentina, the United States, Belgium, and Turkey.
440 patients with 455 consecutive episodes of K. pneumoniae bacteremia between 1 January 1996 and 31 December 1997; of these, 253 episodes were nosocomially acquired.
The K. pneumoniae isolates were examined for the presence of ESBLs. Pulsed-field gel electrophoresis was used to analyze the molecular epidemiology of nosocomial bacteremia with ESBL-producing K. pneumoniae.
Overall, 30.8% (78 of 253) episodes of nosocomial bacteremia and 43.5% (30 of 69) episodes acquired in intensive care units were due to ESBL-producing organisms. After adjustment for potentially confounding variables, previous administration of β-lactam antibiotics containing an oxyimino group (cefuroxime, cefotaxime, ceftriaxone, ceftazidime, or aztreonam) was associated with bacteremia due to ESBL-producing strains (risk ratio, 3.9 [95% CI, 1.1 to 13.8]). In 7 of 10 hospitals with more than 1 ESBL-producing isolate, multiple strains with the same genotypic pattern were observed, indicating patient-to-patient spread of the organism.
Production of ESBLs by Klebsiella pneumoniae is a widespread nosocomial problem. Appropriate infection control and antibiotic management strategies are needed to stem the spread of this emerging form of resistance.
Paterson DL, Ko W, Gottberg AV, Mohapatra S, Casellas JM, Goossens H, et al. International Prospective Study of Klebsiella pneumoniae Bacteremia: Implications of Extended-Spectrum β-Lactamase Production in Nosocomial Infections. Ann Intern Med. 2004;140:26–32. doi: 10.7326/0003-4819-140-1-200401060-00008
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Published: Ann Intern Med. 2004;140(1):26-32.
Hospital Medicine, Multi-Organ Failure and Sepsis, Pulmonary/Critical Care.
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