Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-30T20:18:34.612Z Has data issue: false hasContentIssue false

Klebsiella Pneumoniae Infection on a Rehabilitation Unit: Epidemiologic Typing Methods

Published online by Cambridge University Press:  21 June 2016

W. Thompson
Affiliation:
Section of Infectious Diseases, Departments of Medicine and Medical Microbiology, University of Manitoba, Manitoba
L. Romance
Affiliation:
Infection Control Unit, Health Sciences Centre, Winnipeg, Manitoba
H. Bialkowska-Hobrazanska
Affiliation:
St. Joseph's Health Centre, London, Ontario
F. Ashton
Affiliation:
Department of Microbiology, University of Saskatchewan, Saskatoon, Saskatchewan
L.E. Nicolle*
Affiliation:
Laboratory Centre for Disease Control, Health and Welfare Canada, Ottawa, Ontario
*
Health Sciences Centre, MS673-820 Sherbrook Street, Winnipeg, Manitoba, Canada R3A 1R9

Abstract

Objective:

To identify factors associated with an increased occurrence of Klebsiella pneumoniae isolation in urine cultures and infected wounds on a rehabilitation unit and to compare typing methods for K pneumoniae isolates.

Design:

Retrospective review of laboratory reports and patient records with case-control study. Analysis of K pneumoniae isolates using capsular serotyping, enzyme electrophoretic typing, ribotyping, and DNA typing.

Setting:

48-bed rehabilitation unit in an 1,100-bed tertiary care teaching hospital in Winnipeg, Manitoba.

Results:

In 1988, 20 (19%) of 106 patients admitted to the rehabilitation unit had K pneumoniae isolated from urine or wound, and in 1989 31 (28%) of 111 patients had Klebsiella isolated. Review of ward practices revealed appropriate written policies but evidence of failure in execution leading to multiple opportunities for transmission among patients. Substantial environmental contamination was not identified, although a common urine graduate may have contributed to some transmission. Individuals with K pneumoniae isolated had a significantly longer duration of stay. Many of these were spinal cord-injured patients and were maintained on intermittent catheterization.

One outbreak strain was identified in epidemiologic typing. Other strains were generally identified in individuals with nonnosocomial acquisition of infection. Comparison of epidemiologic typing methods suggests ribotyping may be the optimal method for typing K pneumoniae strains.

Conclusions:

K pneumoniae was acquired frequently by spinal cord-injured patients with extended admissions, re-emphasizing the importance of both patients and stalf following appropriate infection control practices on rehabilitation wards. Ribotyping was the optimal method for typing K pneumoniae isolates.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Nicolle, LE, Buffet, L, Alfieri, N, Tate, R Nosocomial infections on a rehabilitation unit in an acute care hospital. Infect Control Hosp Epidemiol. 1988;9:553557.Google Scholar
2. Montgomerie, JZ. Epidemiology of Klebsiella and hospital-associated infections. Rev Infect Dis. 1979;1:736753.Google Scholar
3. Rennie, RP Duncan, IBR Emergence of gentamicin-resistant Klebsiella in a general hospital. Antimicrob Agents Chemother. 1977;11:179184.Google Scholar
4. Kolmos, HJ. Epidemiological characterization of Klebsiella isolates from patients in a renal department. J Hosp Infect. 1988;11:144149.Google Scholar
5. Kiddy, K, Josse, E, Griffin, N. An outbreak of serious Klebsiella infections related to food blenders. J Hosp Infect. 1987;9:191193.CrossRefGoogle ScholarPubMed
6. Sewell, CM, Koza, MA, Lucki, RJ, Young, EJ. Risk factors associated with a cluster of urinary tract infections in a geriatric unit caused by Klebsiella pneumoniae resistant to multiple antibiotics. Am J Infect Control. 1988;16:6671.Google Scholar
7. Arlet, G. Sanson-le Pons, MJ, Rouveau, M, et al. Outbreak of nosocomial infections due to Klebsiella pneumoniae producing SHV-4 beta-lactamase. Em J Clin Microbiol Infect Dis. 1990;9:797803.Google Scholar
8. Montgomerie, JZ, Gelmore, DS, Graham, IE, et al. Klebsiella pneumoniae colonization in patients with spinal cord injury. Diagn Microbiol Infect Dis. 1987;7:229235.CrossRefGoogle ScholarPubMed
9. Montgomerie, JZ, Gelmore, DS, Ashley, MA, Schick, DG, Jimenes, EM. Long-term colonization of spinal cord injury patients with Klebsiella pneumoniae. J Clin Microbiol. 1989;27:16131616.Google Scholar
10. Walia, S, Madhavan, X Reuman, R Tewari, R, Duckworth, D. Plasmid profiles and klebocin types in epidemiologic studies of infections by Klebsiella pneumoniae. Eur J Clin Microbiol Infect Dis. 1988;7:279284.CrossRefGoogle ScholarPubMed
11. Ayling-Smith, B, Pitt, TL. State of the art in typing Klebsiella spp. J Hosp Infect. 1990;16:287295.Google Scholar
12. Farmin, JJ III, Kelly, MT Enterobacteriacae. In: Balows, A, Hausler, WJ Jr, Herrmann, KL, Isenberg, HD, Shadomy, HJ. Manual of Clinical Microbiology. 5th ed. Washington, DC: American Society of Microbiology; 1991:360383.Google Scholar
13. Casewell, MW. Experiences in the use of commercial antisera for the capsular typing of Klebsiella species. J Clin Pathol. 1972;25:734737.Google Scholar
14. Rennie, RR Duncan, IBR. Emergence of gentamicin-resistant Klebsiella in a general hospital. Antimicrob Agents Chemother. 1977;11:179184.Google Scholar
15. Seiander, RK, Caugant, DA, Ochman, H, Musser, JM, Gilmour, MN, Whittam, TS. Methods of multilocus enzyme electrophoresis for bacterial population genetics and systematics. Appl Environ Microbiol. 1986;51:873884.CrossRefGoogle Scholar
16. Bialkowska-Hobrazanska, H. Detection of enterotoxigenic Escherichia coli by dot blot hybridization with biotinylated DNA probes. J Clin Microbiol. 1987;25:338343.Google Scholar
17. Bialkowska-Hobrazanska, H, Jaskot, D, Hammerberg, O. A method for DNA restriction endonuclease fingerprinting of coagulase-negative staphylococci. J Microbiol Meth. 1990;12:4149.CrossRefGoogle Scholar
18. Southern, EM. Detection of specific sequences DNA fragments separated by gel electrophoresis. J Mol Biol. 1975;98:503517.Google Scholar
19. Bialkowska-Hobrazanska, H, Harry Jaskot, D. Hammerberg 0. Typing of coagulase-negative staphylococci by Southern hybridization of chromosomal DNA fingerprints using a ribosomal RNA probe. Eur J Clin Microbiol. 1990;9:588594.Google Scholar
20. Lewis, RI, Carrion, HM, Lockhart, JL, Politans, VA. Significance of asymptomatic bacteriuria in neurologic bladder disease. Urology. 1984;23:343347.Google Scholar
21. Balke, A, Digiranes A Bacteriuria in patients treated with clean intermittent catheterization. Scand J Infect Dis. 1991;23:577582.Google Scholar
22. Bialkowska-Hobrazanska, H, Jaskot, D, Hammerberg, O. Evaluation of restriction endonuclease fingerprints of chromosomal DNA and_Plasmid profile analysis for characterization of mul-tiresistant coagulase-negative staphylococcus in bacteremic neonates. I Clin Microbiol. 1990:28:269275.Google Scholar
23. Nicolle, LE, Bialkowska-Hobrazanska, H, Romance, L, Harry, VS, Parker, S. Clonal diversity of methicillin-resistant Staphylococcus aureus in an acute care institution. Infect Control Hosp Epidemiol. 1992;13:3337.Google Scholar
24. Bialkowska-Hobrazanska, H, McClory, D, Harry, VS, Richardson, H, Simor, A. Assessment of epidemiologic markers for the detection of multiresistant Serratia marcescens, Klebsiella pneumoniae, and Pseudomonas aeruginosa in a spinal injury unit. Presented at the Annual Meeting of the American Society of Microbiologists, 1987.Google Scholar
25. Haertl, R, Barter, R, Bandlow, G Epidemiological fingerprinting of Klebsiella pneumoniae by small-fragment-restriction-endonucle-ase-analysis. Scand J Infect Dis. 1991;23:737743.Google Scholar
26. Stull, TL, LiPume, JJ, Edlind, TD. Broad-spectrum probe for molecular epidemiology of bacteria: ribosomal RNA. J Infect Dis. 1988;157:280286.Google Scholar
27. Blumberg, HM, Kiehlbauch, JA, Wachsmith, IK. Molecular epidemiology of Yersinia enterocolitica 0:3 infections. Use of chromosomal DNA restriction fragment length polymorphisms of rRNA genes. Clin Microbiol. 1991;29:23682374.Google Scholar
28. Hinojosa-Ahumada, M, Swaminathen, B et al. Restriction fragment length polymorphisms in rRNA opérons for subtyping Shigella sonnei. J Clin Microbiol. 1991;29:23802384.Google Scholar
29. Pitcher, DG, Owen, RJ, Dyal, R Beck, A. Synthesis of a biotynylated DNA probe to detect ribosomal RNA cistrons in Providencia stuartii. FEMS Microbiol Let. 1987;48:283287.Google Scholar
30. Altwegg, M. Hickman-Bremner, FW. Farmer, JJ III. Ribosomal RNA gene restriction patterns provide increased sensitivity of typing Salmonella typhi strains. J Infect Dis. 1989;160:145149.CrossRefGoogle ScholarPubMed
31. Garaizan, J, Kaufman, ME, Pett, TL Comparison of ribotyping with conventional methods for the type identification of Enterobacter cloacae. Clin Microbiol. 1991;29:13031307.CrossRefGoogle Scholar