title: The changing epidemiology of hospital outbreaks due to ESBL-producing Klebsiella pneumoniae: the CTX-M-15 type consolidation.
abstract: Klebsiella pneumoniae is responsible for a large number of hospital outbreaks. In the 1990s, there were clonal epidemics, affecting mostly intensive care patients, which carried SHV and TEM enzyme types. With the advent of CTX-M-15 enzymes in the 2000, plasmids encoding multiple extended-spectrum β-lactamase (ESBL) types were described and, frequently, nosocomial outbreaks reported polyclonal dissemination and involved multiple Enterobacteriaceae. Worryingly, the interface between community and hospital is becoming blurred, and there is increasing evidence for the presence of ESBL-producing K. pneumoniae in the community. Furthermore, carbapenem resistance is increasingly reported in ESBL-producing K. pneumoniae strains. Infection control measures and stewardship programs are vital weapons in controlling the pandemic evolution of multidrug-resistant K. pneumoniae.
authors.affiliation: Service of Internal Medicine, Infectious Disease Unit, Hospital Universitari Mútua de Terrassa, Plaza Dr Robert 5, 08221 Terrassa, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Calbo
authors.affiliation: Service of Internal Medicine, Infectious Disease Unit, Hospital Universitari Mútua de Terrassa, Plaza Dr Robert 5, 08221 Terrassa, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Garau
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D004196:Disease Outbreaks; D004363:Drug Utilization / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000379:methods; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D015995:Prevalence; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; C473109:beta-lactamase CTX-M-15; D001618:beta-Lactamases
keywords: Klebsiella pneumoniae; extended-spectrum β-lactamase; hospital outbreak; β-lactamase CTX-M-15