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An Outbreak of Gentamicin-Resistant Klebsiella pneumoniae: Analysis of Control Measures

Published online by Cambridge University Press:  02 January 2015

Louis D. Saravolatz ,
Lucille Arking ,
Donald Pohlod ,
Evelyn J. Fisher  and
Robert Borer
Louis D. Saravolatz*
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology and Division of Neonatology, Henry Ford Hospital, Detroit, Michigan University of Michigan Medical School, Detroit, Michigan
Lucille Arking
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology and Division of Neonatology, Henry Ford Hospital, Detroit, Michigan University of Michigan Medical School, Detroit, Michigan
Donald Pohlod
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology and Division of Neonatology, Henry Ford Hospital, Detroit, Michigan University of Michigan Medical School, Detroit, Michigan
Evelyn J. Fisher
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology and Division of Neonatology, Henry Ford Hospital, Detroit, Michigan University of Michigan Medical School, Detroit, Michigan
Robert Borer
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology and Division of Neonatology, Henry Ford Hospital, Detroit, Michigan University of Michigan Medical School, Detroit, Michigan
*
Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI 48202
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Abstract

In April 1978, a strain of gentamicin-resistant Klebsiella pneumoniae (GRK) was introduced into the neonatal intensive care unit of Henry Ford Hospital. An additional ten cases of GRK occurred over the subsequent 16 months and intestinal colonization occurred in up to 91% of admissions per month. All GRK were susceptible to amikacin and were capsular serotype 19. Though hand contamination of hospital personnel with GRK was documented, increased handwashing practices did not reduce colonization rates of neonates with the epidemic strain. Intestinal carriage persisted for up to ten months and could not be eradicated by administering oral colistin sulfate. Discontinuation of gentamicin and utilization of amikacin were associated with a significant reduction in colonization with GRK (p < 0.05). However, the only control measure that prevented both new cases and colonization with the epidemic strain was the utilization of a strict cohort system.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 5 , Issue 2 , February 1984 , pp. 79 - 84
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1984

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References

1.Allen, JR, Oliver, TK, The newborn nursery, in Bennett, JV, Brachman, PS (eds): Hospital Infections. Boston, Little Brown & Company, 1979, pp 104–115.Google Scholar
2.Adler, JL, Shulman, JA, Terry, PM, et al: Nosocomial colonization with kanamycin-resistant Klebsiella pneumoniae, types 2 and 11, in a premature nursery. J Pediatr 1970;77:376–385.CrossRefGoogle Scholar
3.Hable, KA, Matsen, JM, Wheeler, DJ, et al: Klebsiella type 33 septicemia in an infant intensive care unit. J Pediatr 1972;80:920–924.CrossRefGoogle Scholar
4.Eisenach, KD, Reber, RM, Eitzman, DV, et al: Nosocomial infections due to kanamycin-resistant, (R)-factor carrying enteric organisms in an intensive care nursery. Pediatrics 1972;50:395–402.CrossRefGoogle Scholar
5.Hill, HR, Hunt, CE, Matsen, JM, Nosocomial colonization with Kleb-siella, type 26, in a neonatal intensive care unit associated with an outbreak of sepsis, meningitis and necrotizing enterocolitis. J Pediatr 1974;85:415–419.CrossRefGoogle Scholar
6.Crosson, FJ, Moxon, ER, Factors influencing kanamycin-resistance in gram-negative enteric neonatal sepsis. Pediatrics 1978;61:488–489.CrossRefGoogle ScholarPubMed
7.Eidelman, AL, Reynolds, J, Gentamicin-resistant Klebsiella infections in a neonatal intensive care unit. Am J Dis Child 1978;132:421–422.Google Scholar
8.Mayhall, CG, Lamb, VA, Bitar, CM, et al: Nosocomial Klebsiella infection in a neonatal unit: Identification of risk factors in gastrointestinal colonization. Infect Control 1980;1:239–246.CrossRefGoogle Scholar
9.Wenzel, RP, Osterman, CA, Hunting, KJ, et al: Hospital-acquired infections. I. Surveillance in a university hospital. Am J Epidemiol 1976;103:251–260.CrossRefGoogle ScholarPubMed
10.Wenzel, RP, Osterman, CA, Hunting, KJ, Hospital-acquired infections. II. Infection rates by site, service and common procedures in a university hospital. Am J Epidemiol 1976;104:645–651.CrossRefGoogle ScholarPubMed
11.National Committee for Clinical Laboratory Standards Subcommittee on Antimicrobial Susceptibility Testing. Performance Standards for Antimicrobial Disc Susceptibility Tests. Villanova, Pennsylvania, National Committee for Clinical Laboratory Standards, 1975.Google Scholar
12.Washington, JA, Sutter, VL, Dilution susceptibility test: Agar and macro-broth dilution procedures, in Lennette, EH, Balows, A, Housler, WJ, et al (eds): Manual of Clinical Microbiology. Washington, DC, American Society for Microbiology, 1980, pp 453–458.Google Scholar
13.Steers, E, Foltz, EL, Graves, BS, An inoculum replicating apparatus for routine testing of bacterial susceptibility to antibiotics. Antibiot Chemother 1959;9:307–311.Google Scholar
14.Beneveniste, R, Davies, J, R-factor mediated gentamicin resistance. A new enzyme which modifies aminoglycoside antibiotics. FEBS Lett 1971;14:293.CrossRefGoogle Scholar
15.Price, KE, DeFuria, MD, Pursiano, TA, Amikacin, an aminoglycoside with marked activity against antibiotic-resistant clinical isolates. J Infect Dis 1976;134:S249.CrossRefGoogle ScholarPubMed
16.Davies, J, Courvalin, P, Mechanisms of resistance to aminoglycosides. Am J Med 1977;9:25–29.Google Scholar
17.Montgomerie, JZ, Epidemiology of klebsiella and hospital-associated infection. Rev Infect Dis 1979;1:736–753.CrossRefGoogle Scholar
18.Goldmann, DA, Bacterial colonization and infection in the neonate. Am J Med 1981;70:417–422.CrossRefGoogle Scholar
19.Casewell, M, Phillips, I, Hands as a route of transmission for klebsiella species. Br Med J 1977;2:1315–1317.CrossRefGoogle ScholarPubMed
20.Damato, JJ, Eitzman, DV, Baer, H, Persistence and dissemination in the community of R-factors of nosocomial origin. J Infect Dis 1974;129:205–209.CrossRefGoogle ScholarPubMed
21.Sande, MA, Mandeli, GL, Antimicrobial agents, in Goodman, LS, Gilman, A (eds): The Pharmacological Basis of Therapeutics. New York, MacMillan Publishing Co, 1980, pp 1222–1248.Google Scholar