title: Epidemiology of infections caused by gentamicin-resistant enterobacteriaceae and Pseudomonas aeruginosa over 15 years at the Nashville Veterans Administration Medical Center.
abstract: Nosocomial infections and gentamicin resistance were surveyed over 15 years at Nashville Veterans Administration Medical Center, and trends for Enterobacteriaceae and Pseudomonas aeruginosa were contrasted. Analysis of approximately 6,000 nosocomial infections indicated that four-fifths were caused by aerobic gram-negative bacilli. Three hospital-wide outbreaks caused by Enterobacteriaceae occurred; these three outbreaks were due to Serratia marcescens, Klebsiella pneumoniae, and Enterobacter cloacae, respectively. The outbreaks were temporally related to the emergence of gentamicin resistance. Detailed analysis of the recent outbreak due to Enterobacter indicated that an increasing prevalence of gentamicin-resistant E. cloacae predated nosocomial infections by several months; this pattern suggested that such outbreaks could be predicted. Molecular epidemiologic data pertaining to the preservation over a decade of genes encoding gentamicin resistance were reviewed. In contrast to Enterobacteriaceae, P. aeruginosa gradually and progressively developed resistance to gentamicin that spread in an endemic fashion, with parallel increases in nosocomial infections. This pattern appeared to relate to different modes of spread and persistence for resistant P. aeruginosa that may require unique methods for control.
authors.affiliation: Medical Service, Nashville Veterans Administration Medical Center, Tennessee.
authors.forename: R H
authors.initials: RH
authors.lastname: Alford
authors.forename: A
authors.initials: A
authors.lastname: Hall
mesh_terms: D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D004352:Drug Resistance, Microbial; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology*; D004812:Epidemiologic Methods; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000453:epidemiology*; D013714:Tennessee
chemical_list: D005839:Gentamicins