title: Molecular epidemiology of a citywide outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infection.
abstract: Multidrug-resistant strains of Klebsiella pneumoniae are a problem in many hospitals. In 1999, the molecular epidemiology of K. pneumoniae with extended-spectrum beta-lactamases (ESBLs) was studied at 15 hospitals in Brooklyn. Of 824 unique patient isolates, 34% were presumptive ESBL producers. Of this subset, 34% were susceptible to cefoxitin, 42% to ciprofloxacin, 48% to ceftriaxone, 55% to piperacillin-tazobactam, 57% to amikacin, and 86% to cefepime. Ribotype analysis revealed 87 unique types. However, 2 clusters accounted for 35% of isolates and were present in most of the hospitals. One cluster was significantly more resistant to most antibiotics. Although there was a predominance of SHV-5, considerable heterogeneity of beta-lactamases was evident, even among isolates of the same cluster. A correlation was found between the use of cephalosporins and the prevalence of ESBL-producing strains of K. pneumoniae at each hospital. Our data suggest that there is an advanced outbreak of multidrug-resistant K. pneumonia infection that is affecting all Brooklyn hospitals.
authors.affiliation: Infectious Diseases Division, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Quale
authors.forename: David
authors.initials: D
authors.lastname: Landman
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Bradford
authors.forename: Melissa
authors.initials: M
authors.lastname: Visalli
authors.forename: Jayshree
authors.initials: J
authors.lastname: Ravishankar
authors.forename: Carlos
authors.initials: C
authors.lastname: Flores
authors.forename: David
authors.initials: D
authors.lastname: Mayorga
authors.forename: Kalyani
authors.initials: K
authors.lastname: Vangala
authors.forename: Adedeyo
authors.initials: A
authors.lastname: Adedeji
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks; D004363:Drug Utilization; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D009519:New York City / Q000453:epidemiology; D021521:Ribotyping; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D001618:beta-Lactamases