title: Sequential emergence of multi-resistant Klebsiella pneumoniae in Bahrain.
abstract: During the mid-1980s, nosocomial infections due to aminoglycoside-resistant Klebsiella pneumonia were prevalent in the intensive care unit (ICU) of the Salamanya Medical Centre, Bahrain. In an attempt to control the spread of such organisms, the third-generation cephalosporins were introduced in early 1987. Subsequently there was a marked increase in the incidence of cephalosporin resistance among Klebsiella spp. isolated in the ICU. In 1990, over 60% of Klebsiella isolates were resistant to both cephalosporins and aminoglycosides. Cephalosporin resistance was due to production of extended-spectrum beta-lactamases encoded on the same plasmid as aminoglycoside resistance. The incidence of cephalosporin resistance declined during 1991-1992, which was coincident with severe restrictions on the use of third-generation cephalosporins and the preferential use of ciprofloxacin and imipenem for nosocomial klebsiella infections. Sequential overuse of aminoglycosides and cephalosporins for nosocomial klebsiella infection may select for organisms resistant to both classes of antibiotics.
authors.affiliation: Department of Internal Medicine, Naval Medical Center, San Diego, California 92134-5000, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Wallace
authors.forename: A P
authors.initials: AP
authors.lastname: Johnson
authors.forename: M
authors.initials: M
authors.lastname: Daniel
authors.forename: M
authors.initials: M
authors.lastname: Malde
authors.forename: A A
authors.initials: AA
authors.lastname: Yousif
mesh_terms: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001445:Bahrain / Q000453:epidemiology; D018550:Cephalosporin Resistance / Q000502:physiology*; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use; D003422:Critical Care; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D018432:Drug Resistance, Multiple / Q000502:physiology*; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000472:pathogenicity; D010957:Plasmids / Q000235:genetics; D012189:Retrospective Studies; D013997:Time Factors; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D001618:beta-Lactamases