Impact of a clonal outbreak of extended-spectrum b-lactamase producing Klebsiella pneumoniae in the development and evolution of bloodstream infections by K. pneumoniae and Escherichia coli: an 11 year experience in Oxfordshire, UK

Webster, D P, Young, B C, Morton, R, Collyer, D, Batchelor, B, Turton, J F, Maharjan, S, Livermore, D M, Bejon, P, Cookson, B D and Bowler, C J W (2011) Impact of a clonal outbreak of extended-spectrum b-lactamase producing Klebsiella pneumoniae in the development and evolution of bloodstream infections by K. pneumoniae and Escherichia coli: an 11 year experience in Oxfordshire, UK. Journal of Antimicrobial Chemotherapy, 66 (9). pp. 2126-2135. ISSN 0305-7453

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Abstract

Objectives: The objectives of this study were: (i) to describe an outbreak of multidrug-resistant Klebsiella pneumoniae
in our population; (ii) to identify the potential source of this outbreak by examining antibiotic resistance
trends in urocultures; (iii) to evaluate the contribution of this outbreak to resistance patterns over time in the
two commonest Gram-negative blood culture isolates, namely K. pneumoniae and Escherichia coli; and (iv) to
assess risk factors for multidrug resistance and the impact of this resistance on mortality and length of stay.
Methods: We searched Microbiology and Patient Administration Service databases retrospectively and describe
resistance trends in E. coli and K. pneumoniae bloodstream infections (BSIs) in Oxfordshire, UK, over an 11 year
period.
Results: An outbreak of a multidrug-resistant, CTX-M-15 extended-spectrum b-lactamase (ESBL)-producing
K. pneumoniae clone was identified and shown by multilocus sequence typing to belong to a novel sequence
type designated ST490. This was associated with a sporadic change in resistance rates in K. pneumoniae BSIs
with rates of multidrug resistance (defined as resistance to three or more antibiotic classes) reaching 40%.
A case–control study showed prior antibiotic exposure as a risk factor for infection with this organism.
During the same time period, rates of ESBL-producing Klebsiella spp. isolated from urocultures increased
from 0.5% to almost 6%. By contrast, the rate of multidrug resistance in E. coli rose more steadily from 0%
in 2000 to 10% in 2010.
Conclusions: Changes in resistance rates may be associated with outbreaks of resistant clones in K. pneumoniae.
Changing resistance patterns may affect important health economic issues such as length of stay.

Item Type: Article
Keywords: ESBLs, multidrug resistance, BLR
Schools and Departments: Brighton and Sussex Medical School > Clinical Medicine
Subjects: R Medicine > RC Internal medicine > RC0109 Infectious and parasitic diseases
Depositing User: Ellen Thomas
Date Deposited: 29 Oct 2012 09:55
Last Modified: 29 Oct 2012 09:55
URI: http://sro.sussex.ac.uk/id/eprint/41630
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