Epidemiology and molecular characterization of nosocomially transmitted multidrug-resistant Klebsiella pneumoniae

• Published in: International journal of infectious diseases 2000, Vol.4 (3), p.123-128
• Main Authors: Parasakthi, Navaratnam, Vadivelu, Jamuna, Ariffin, Hany, Iyer, Lakshmy, Palasubramaniam, Selvi, Arasu, Anusha
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; beta-Lactamases - metabolism; Biological and medical sciences; Child; Cross Infection - epidemiology; Cross Infection - microbiology; Disease Outbreaks; Drug Resistance, Microbial - genetics; Drug Resistance, Multiple - genetics; Electrophoresis, Gel, Pulsed-Field; extended-spectrum beta-lactamase; Humans; Klebsiella Infections - epidemiology; Klebsiella Infections - microbiology; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - genetics; Male; Medical sciences; Microbial Sensitivity Tests; Molecular Epidemiology; multiresistant Klebsiella pneumoniae; nosocomial outbreak; Pharmacology. Drug treatments; Plasmids - genetics; Prospective Studies; Tropical medicine
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/S1201-9712(00)90072-9

Objectives: To describe the epidemiology, antimicrobial susceptibility, genomic profiles, and control of a nosocomial outbreak of multidrug-resistant Klebsiella pneumoniae (MRKP) that occurred in the pediatric oncology unit of the University of Malaya Medical Centre in Kuala Lumpur. Materials and Methods: A prospective epidemiologic and microbiologic study was conducted of MRKP isolated from the blood and wound of a boy with necrotizing fascilities after a 7-day course of ceftazidime and amikacin. In the following 2 weeks, phenotypically similar MRKP were isolated from the blood cultures of four other patients and rectal swabs of another three patients and two liquid soap samples located in the same ward. Results: Antimicrobial profiles demonstrated that all the isolates were resistant to ceftazidime, sensitive to imipenem and ciprofloxacin, and confirmed to be extended-spectrum beta-lactamase producers. Plasmids of varying molecular weights were present in all isolates. In eight of these isolates, which included four from blood, there were common large molecular weight plasmids ranging from 80 kb to 100 kb. Pulsed-field gel electrophoresis analysis using Xbal demonstrated six different DNA profiles, A to F. Profile A was shared by two blood culture isolates and were related by 91%. Profile B was found in one rectal swab isolate and one isolate from liquid soap and were related by 94%. Profile C was shared by one blood isolate and one liquid soap isolate and showed 100% relatedness. Profiles D, E, and F each were demonstrated by one blood isolate and two rectal swab isolates, respectively. These showed only 65% relatedness. Conclusions: The MRKP strains in this outbreak were not clonal in origin. The decline of the outbreak after 4 weeks was attributed to the reemphasis of standard infection control procedures and the implementation of a program that addressed sites of environmental contamination.