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Increased Mortality Associated With a Clonal Outbreak of Ceftazidime-Resistant Klebsiella pneumoniae: A Case–Control Study

Published online by Cambridge University Press:  21 June 2016

Abdul Qavi ,
Sorana Segal-Maurer ,
Noriel Mariano ,
Carl Urban ,
Carl Rosenberg ,
Janice Burns ,
Tom Chiang ,
James Maurer  and
James J. Rahal
Abdul Qavi
Affiliation:
Infectious Disease Section and the Department of Medicine, New York Hospital Medical Center of Queens, Flushing, New York
Sorana Segal-Maurer*
Affiliation:
Infectious Disease Section and the Department of Medicine, New York Hospital Medical Center of Queens, Flushing, New York Department of Medicine, Weill Medical College of Cornell University, New York, New York
Noriel Mariano
Affiliation:
Infectious Disease Section and the Department of Medicine, New York Hospital Medical Center of Queens, Flushing, New York
Carl Urban
Affiliation:
Infectious Disease Section and the Department of Medicine, New York Hospital Medical Center of Queens, Flushing, New York Department of Microbiology, Weill Medical College of Cornell University, New York, New York
Carl Rosenberg
Affiliation:
Department of Emergency Medicine, New York Hospital Medical Center of Queens, Flushing, New York
Janice Burns
Affiliation:
Department of Nursing, New York Hospital Medical Center of Queens, Flushing, New York
Tom Chiang
Affiliation:
Infectious Disease Section and the Department of Medicine, New York Hospital Medical Center of Queens, Flushing, New York
James Maurer
Affiliation:
Department of Surgery, New York Hospital Medical Center of Queens, Flushing, New York
James J. Rahal
Affiliation:
Infectious Disease Section and the Department of Medicine, New York Hospital Medical Center of Queens, Flushing, New York Department of Medicine, Weill Medical College of Cornell University, New York, New York
*
Infectious Disease Section, New York Hospital Medical Center of Queens, 56-45 Main Street, Flushing, NY 11355[email protected]
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Abstract

Objectives:

To determine risk factors for ceftazidime-resistant Klebsiella pneumoniae infection and the effect of cef-tazidime-resistant K. pneumoniae infection on mortality during an isolated outbreak.

Design:

Case–control investigation using clinical and molecular epidemiology and prospective analysis of infection control interventions.

Setting:

Surgical intensive care unit of a university-affiliated community hospital.

Patients:

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 1 , January 2005 , pp. 63 - 68
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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