Epidemiology of ceftazidime-resistant Klebsiella pneumoniae in a large university hospital in Tel Aviv.
BACKGROUND
An increase in multiple drug-resistant Klebsiella pneumoniae due to extended spectrum beta-lactamase production has recently been reported from many centers around the world. There is no information in the literature regarding this problem in Israel. A high prevalence of ceftazidime-resistant K. pneumoniae was noted in our Intensive Care Unit in the first few months of 1995.


OBJECTIVE
To describe the epidemiology of ceftazidime-resistant K. pneumoniae in our medical center, as representing the situation in tertiary care hospitals in Israel.


METHODS
We vigorously restricted the use of ceftazidime in the ICU and enforced barrier precautions. The susceptibility rate of K. pneumoniae was surveyed in the ICU and throughout the hospital before and after the intervention in the ICU.


RESULTS
Following the intervention, the susceptibility rate of K. pneumoniae increased from 11% (3/28) to 47% (14/30) (P < 0.01) among ICU isolates, from 55% (154/280) to 62% (175/281) (P = 0.08) among total hospital isolates, and from 61% (50/82) to 74% (84/113) (P < 0.05) among total hospital blood isolates, although no additional control measures were employed outside the ICU.


CONCLUSIONS
The epidemiology of ceftazidime-resistant K. pneumoniae in our medical center is similar to that reported from other centers around the world. Early awareness to the emergence of this resistance, identification of the source of the epidemic, and prompt action at the putative source site may reduce the rate of acquisition and spread of such resistance inside and outside of the source unit.
Noy
A
A
Infectious Diseases Unit, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Orni-Wasserlauf
R
R
Sorkine
P
P
Siegman-Igra
Y
Y
D002442:Ceftazidime / Q000008:administration & dosage / Q000494:pharmacology*; D002511:Cephalosporins / Q000008:administration & dosage / Q000494:pharmacology*; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000453:epidemiology; D004352:Drug Resistance, Microbial; D006785:Hospitals, University / Q000706:statistics & numerical data; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007557:Israel / Q000453:epidemiology; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D011336:Probability; D012307:Risk Factors; D001618:beta-Lactamases / Q000187:drug effects* / Q000378:metabolism
D002511:Cephalosporins; D002442:Ceftazidime; D001618:beta-Lactamases