title: Increased mortality associated with a clonal outbreak of ceftazidime-resistant Klebsiella pneumoniae: a case-control study.
abstract: OBJECTIVE
  To determine risk factors for ceftazidime-resistant Klebsiella pneumoniae infection and the effect of ceftazidime-resistant K. pneumoniae infection on mortality during an isolated outbreak.
  
  
  METHODS
  Case-control investigation using clinical and molecular epidemiology and prospective analysis of infection control interventions.
  
  
  METHODS
  Surgical intensive care unit of a university-affiliated community hospital.
  
  
  METHODS
  Fourteen case-patients infected with ceftazidime-resistant K. pneumoniae and 14 control-patients.
  
  
  RESULTS
  Ten of 14 case-patients had identical strains by pulsed-field gel electrophoresis. Broad-spectrum antibiotic therapy before admission to the unit was strongly predictive of subsequent ceftazidime-resistant K. pneumoniae infection. In addition, patients with ceftazidime-resistant K. pneumoniae infection experienced increased mortality (odds ratio, 3.77).
  
  
  CONCLUSIONS
  Cephalosporin restriction has been shown to decrease the incidence of nosocomial ceftazidime-resistant K. pneumoniae. However, isolated clonal outbreaks may occur due to lapses in infection control practices. Reinstatement of strict handwashing, thorough environmental cleaning, and repeat education led to termination of the outbreak. A distinct correlation between ceftazidime-resistant K. pneumoniae infection and mortality supports the important influence of antibiotic resistance on the outcome of serious bacterial infections.
authors.affiliation: Infectious Disease Section, Department of Medicine, New York Hospital Medical Center of Queens, Flushing, New York 11355, USA.
authors.forename: Abdul
authors.initials: A
authors.lastname: Qavi
authors.forename: Sorana
authors.initials: S
authors.lastname: Segal-Maurer
authors.forename: Noriel
authors.initials: N
authors.lastname: Mariano
authors.forename: Carl
authors.initials: C
authors.lastname: Urban
authors.forename: Carl
authors.initials: C
authors.lastname: Rosenberg
authors.forename: Janice
authors.initials: J
authors.lastname: Burns
authors.forename: Tom
authors.initials: T
authors.lastname: Chiang
authors.forename: James
authors.initials: J
authors.lastname: Maurer
authors.forename: James J
authors.initials: JJ
authors.lastname: Rahal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016022:Case-Control Studies; D002442:Ceftazidime / Q000494:pharmacology; D002999:Clone Cells; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D002442:Ceftazidime