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Impact of a clonal outbreak of extended-spectrum beta-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



Impact of a clonal outbreak of extended-spectrum beta-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







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. 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. An outbreak of a multidrug-resistant, CTX-M-15 extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae clone was identified and shown by multilocus sequence typing to belong to a novel sequence type designated ST49. 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 4%. 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 .5% to almost 6%. By contrast, the rate of multidrug resistance in E. coli rose more steadily from % in 2 to 1% in 21. 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.

Accession: 036174096

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