Carriage rate of carbapenem-resistant Klebsiella pneumoniae in hospitalised patients during a national outbreak
| Autor: | Tamar Lachish, Yechiel Schlesinger, David Raveh, Yonit Wiener-Well, Bernard Rudensky, Puah Kopuit, Ellen Broide, Amos M. Yinnon |
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| Rok vydání: | 2010 |
| Předmět: |
Male
Carbapenem Klebsiella pneumoniae Drug resistance Disease Outbreaks Risk Factors Epidemiology Prevalence Israel Child Antibacterial agent Aged 80 and over biology General Medicine Middle Aged Anti-Bacterial Agents Bacterial Typing Techniques Electrophoresis Gel Pulsed-Field Infectious Diseases Child Preschool Carrier State Vancomycin Female medicine.drug Adult Microbiology (medical) medicine.medical_specialty Adolescent Sensitivity and Specificity beta-Lactam Resistance Young Adult Predictive Value of Tests Internal medicine medicine Humans Aged business.industry Infant Newborn Rectum Infant Outbreak biology.organism_classification DNA Fingerprinting Klebsiella Infections Surgery Carriage Carbapenems Case-Control Studies business |
| Zdroj: | Journal of Hospital Infection. 74:344-349 |
| ISSN: | 0195-6701 |
| Popis: | Summary During a national outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) in Israel, we conducted a point prevalence survey to determine the extent of asymptomatic carriage. Subsequently, a retrospective case–control study was done, comparing carriers of CRKP with non-carriers, in order to detect risk factors for carriage. Oral, perianal and rectal swabs were obtained from all hospitalised eligible and consenting patients. Selective media for carbapenem-resistant Gram-negative bacteria were used and pulsed-field gel electrophoresis (PFGE) helped to determine clonal source. Culture was obtained from 298 patients. Sixteen (5.4%) were carriers of CRKP, with a higher carriage rate in medical and surgical wards. Only 18% of carriers were treated with any carbapenem prior to the survey. Five of the 16 carriers had a positive clinical specimen for CRKP, hence a clinical infection versus asymptomatic carriage ratio of 1:3. The rectum was the most sensitive site sampled, detecting 15/16 carriers, and the overall sensitivity of the method was 94% with a negative predictive value of 99.6%. In a multivariate analysis of risk factors for CRKP carriage, three variables were significantly related to carriage state: diaper use, longer duration of hospital stay and vancomycin use. PFGE demonstrated that all 16 isolates were identical, confirming clonal origin. A point prevalence survey performed at a single medical centre during an outbreak of CRKP demonstrated a carriage rate of 5.4%. The clonal origin of these isolates suggests that strict adherence to isolation procedure may contain this outbreak. |
| Databáze: | OpenAIRE |
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