Spread of klebsiella pneumoniae with extended-spectrum beta-lactamases (ESBLs) in patients with neurologic injury

W. E. Bischoff, Christopher Emery

Research output: Contribution to journalArticle

Abstract

Few data are available about the epidemiology and clinical significance of infections with enterobacteriaceae producing ESBLs. Using biotyping, MIC testing, molecular techniques and medical record reviews, the epidemiology of strain dissemination in infected patients at an 850 bed tertiary care hospital was investigated. During a six month study period, 197 patients had clinical isolates with elevated MIC to 3rd generation cephalosporins (3rd ceph). These isolates were tested for ESBLs. Of 23 patients with clinical isolates producing ESBL, 12 were infected with Klebsiella pneumoniae (EPKP). 8 of the 12 patients had severe neurologic injuries with a neurogenic bladder, 2 had pancreatitis, 1 had leukemia and 1 had an abdominal gun shot. In all 8 neurologic patients EPKP caused UTIs, including 1 patient with a concurrent bacteremia. The infection sites of the remaining patients were abdominal fluid, abdominal abscess (paucr.), lung (leuk.) and urinary tract system (gun shot). PFGE demonstrated two groups of related isolates. 3 clonally related EPKP were found in the neurologic patients. The patients were located on the same unit, underwent repeated bladder catheterizations and had previously received 3rd ceph. All isolates showed identical plasmid, biotyping and MIC patterns. The second group included two neurologic patients from different units with no identified links to each other. Patients with severe neurologic injuries are at high risk for colonization and infection with antibiotic resistant organisms such as EPKP. The combination of neurogenic bladder as an ideal reservoir for microorganisms, repeated bladder catheterization and treatment with 3rd ceph increases the risk not only for infection but also for transmission of these pathogens. Molecular techniques are useful tools in the evaluation of enterobacteriaceae with ESBLs.

Original languageEnglish (US)
Pages (from-to)495
Number of pages1
JournalClinical Infectious Diseases
Volume25
Issue number2
StatePublished - 1997
Externally publishedYes

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Nervous System Trauma
Klebsiella pneumoniae
beta-Lactamases
Cephalosporins
Nervous System
Neurogenic Urinary Bladder
Firearms
Catheterization
Enterobacteriaceae Infections
Epidemiology
Urinary Bladder
Abdominal Abscess
Infectious Disease Transmission
Enterobacteriaceae
Tertiary Healthcare
Bacteremia
Infection
Urinary Tract
Tertiary Care Centers
Pancreatitis

ASJC Scopus subject areas

  • Immunology

Cite this

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abstract = "Few data are available about the epidemiology and clinical significance of infections with enterobacteriaceae producing ESBLs. Using biotyping, MIC testing, molecular techniques and medical record reviews, the epidemiology of strain dissemination in infected patients at an 850 bed tertiary care hospital was investigated. During a six month study period, 197 patients had clinical isolates with elevated MIC to 3rd generation cephalosporins (3rd ceph). These isolates were tested for ESBLs. Of 23 patients with clinical isolates producing ESBL, 12 were infected with Klebsiella pneumoniae (EPKP). 8 of the 12 patients had severe neurologic injuries with a neurogenic bladder, 2 had pancreatitis, 1 had leukemia and 1 had an abdominal gun shot. In all 8 neurologic patients EPKP caused UTIs, including 1 patient with a concurrent bacteremia. The infection sites of the remaining patients were abdominal fluid, abdominal abscess (paucr.), lung (leuk.) and urinary tract system (gun shot). PFGE demonstrated two groups of related isolates. 3 clonally related EPKP were found in the neurologic patients. The patients were located on the same unit, underwent repeated bladder catheterizations and had previously received 3rd ceph. All isolates showed identical plasmid, biotyping and MIC patterns. The second group included two neurologic patients from different units with no identified links to each other. Patients with severe neurologic injuries are at high risk for colonization and infection with antibiotic resistant organisms such as EPKP. The combination of neurogenic bladder as an ideal reservoir for microorganisms, repeated bladder catheterization and treatment with 3rd ceph increases the risk not only for infection but also for transmission of these pathogens. Molecular techniques are useful tools in the evaluation of enterobacteriaceae with ESBLs.",
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