title: Induction and nosocomial dissemination of carbapenem and polymyxin-resistant Klebsiella pneumoniae.
abstract: BACKGROUND
  Polymyxins are antimicrobial agents capable of controlling carbapenemase-producing Klebsiella pneumoniae infection.
  
  
  METHODS
  We report a cluster of four patients colonized or infected by polymyxin-resistant and Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae.
  
  
  RESULTS
  Three patients were hospitalized in adjacent wards, and two were admitted to the intensive care unit. The index case maintained prolonged intestinal colonization by KPC-producing K. pneumoniae. Three patients received polymyxin B before the isolation of polymyxin-resistant K. pneumoniae.
  
  
  CONCLUSIONS
  Colonization by KPC-producing K. pneumoniae and previous use of polymyxin B may be causally related to the development of polymyxin-resistant microorganisms.
authors.affiliation: Serviço de Controle de Infecção Hospitalar, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, BR.
authors.forename: Gilberto Gambero
authors.initials: GG
authors.lastname: Gaspar
authors.affiliation: Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, BR.
authors.forename: Fernando
authors.initials: F
authors.lastname: Bellissimo-Rodrigues
authors.affiliation: Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, São Paulo, BR.
authors.forename: Leonardo Neves de
authors.initials: LN
authors.lastname: Andrade
authors.affiliation: Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, São Paulo, BR.
authors.forename: Ana Lúcia
authors.initials: AL
authors.lastname: Darini
authors.affiliation: Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, BR.
authors.forename: Roberto
authors.initials: R
authors.lastname: Martinez
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology; D003428:Cross Infection / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011113:Polymyxins / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D011113:Polymyxins