title: Extended Spectrum Beta-Lactamase-producing Klebsiella pneumoniae outbreaks during a third generation cephalosporin restriction policy.
abstract: In spite of the adoption of third generation cephalosporin restriction policies, two independent outbreaks by Extended Spectrum Beta-Lactamase (ESBL)-producing Klebsiella pneumoniae occurred in two different wards (Neonatal Intensive Care Unit, NICU and Neurosurgery) of a teaching hospital in Rome, Italy. In the former 19 infected neonates were reported, whereas in the latter there were 10 infected patients. In both wards no differences were observed in the mortality rates in periods of outbreak and those with no outbreak. Molecular typing on a total of 19 isolated strains was carried out and restriction patterns were compared. The PFGE showed that nine isolates responsible for infection in the NICU were all included in three closely related clusters. In Neurosurgery nine strains out of ten were strictly related and part of an outbreak occurring between August-December 2003, while one isolate was temporarily (February 2003) and genetically (seven band differences) unrelated to the outbreak strains. When ESBL producing K. pneumoniae clusters from the two wards (NICU vs Neurosurgery) were compared, they appeared to be completely different both for their genotype pattern and plasmid type or presence, thus demonstrating cross transmission by two different genotypes.
authors.affiliation: Department of Public Health "G Sanarelli", University of Rome "La Sapienza", Rome, Italy.
authors.forename: M P
authors.initials: MP
authors.lastname: Conte
authors.forename: M
authors.initials: M
authors.lastname: Venditti
authors.forename: F
authors.initials: F
authors.lastname: Chiarini
authors.forename: G
authors.initials: G
authors.lastname: D'Ettorre
authors.forename: I
authors.initials: I
authors.lastname: Zamboni
authors.forename: G L
authors.initials: GL
authors.lastname: Scoarughi
authors.forename: C
authors.initials: C
authors.lastname: Gallinelli
authors.forename: G B
authors.initials: GB
authors.lastname: Orsi
mesh_terms: D002511:Cephalosporins / Q000627:therapeutic use*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D018432:Drug Resistance, Multiple; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007558:Italy; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D002511:Cephalosporins; D001618:beta-Lactamases