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Query: UMLS:C0519030 (Klebsiella)
 21,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Resistant strains of Klebsiella pneumoniae were found in increasing frequency as a cause of nosocomial infection in an intensive care unit between July and October 1990. The isolated strains had an almost identical biochemical profile, showed a similar pattern of antibiotic resistance, and produced type SHV2-broad-spectrum betalactamase. Thus, it was assumed that the isolates were copies of identical strains, causing an outbreak of nosocomial infections. The bacteria were resistant to third-generation cephalosporins, such as cefotiam, cefotaxime and ceftriaxone, and also to aminoglycosides and acylaminopenicillins. Approximately half of the strains were resistant to ceftazidim and aztreonam. The bacteria were sensitive in vitro to ciprofloxacin, imipenem, latamoxef and cefotetan. During three months, 10% (11) of all patients became infected; four of these patients (36%) died from septicemia. After conventional hygiene programs had failed to stop the outbreak, the intensive care unit was closed and disinfected, a measure, which effectively interrupted the infection.
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PMID:[Outbreak of a nosocomial infection of SHV2-beta-lactamase-containing Klebsiella pneumonia strains in an operative intensive care unit]. 156 56

Agents etiologically relevant to hospital infection have been studied in an oncologic clinic for the period of 20 years since 1969. Pronounced changes in the profile of basic infections have been observed. In 1969, Staphylococcus accounted for 46% of cases of infection and E. coli was isolated in 22% whereas in 1987 and 1988, the respective figures for staphylococcus were 18 and 16% only while for E. coli--8.4 and 8.6%, respectively. At the same time, the occurrence of all types of streptococcal infections has risen from 17 to 26-27%. As regards gram-negative bacilli such as Klebsiella spp., Ps. aeruginosa, Enterobacter, Acinetobacter and Serrata spp., their share has increased and spectrum has become wider. The level and spectrum of drug resistance have changed, too. The level of plasmid genes accounting for resistance and pathogenicity in bacterial genomes, particularly, in gram-negative bacilli, have increased. Formation of multidrug resistant strains was shown to depend both on intensity of drug treatment in the clinic and presence and activity of R plasmids, particularly, with a wide spectrum of hosts.
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PMID:[The resistance of the bacterial flora in cancer patients to drug therapy]. 166 98

The rate of nosocomial infections was determined during a 9-month study in a 6-year-old hospital in north Saudi Arabia. The overall rate of nosocomial infection in the hospital was 2.2%. The rates in the different services varied. The highest were in the Special Care Baby Unit (13.5%) and Intensive Care Unit (6%). In the other services it ranged from 1 to 3.5%. The common causal agents of documented infections were Escherichia coli (81), Pseudomonas aeruginosa (55), Staphylococcus aureus (43), Klebsiella spp. (23), Candida spp. (15), Proteus spp. (14), enterococci (13), Enterobacter spp. (7), Acinetobacter spp. (2) and Providencia sp. (1). The most commonly infected sites from which these organisms were isolated were urine (133), wounds (48), umbilical cord (18), high vaginal infection (13), blood (11), burn respiratory tract infection (10 each).
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PMID:Prevalence of nosocomial infections in a Saudi Arabian teaching hospital. 167 53

In July 1984 Klebsiella pneumoniae producing beta-lactamase CTX-1(TEM-3) (K. pneumoniae-CTX-1) spread from an Intensive Care Unit (ICU) throughout the hospitals of Clermont-Ferrand, France, and were isolated in four other hospitals of the region. A retrospective case control study was conducted in the ICU to characterize the risk factors for nosocomial infection with this organism. The cases were the 74 patients who had had K. pneumoniae-CTX-1 isolated from one or more clinical samples between July 1984 and December 1987. They were compared with 74 controls for host risk factors, underlying disease, procedures and antibiotic treatment. The monthly incidence of infection/colonization varied from 0% to 14.6%. The mortality rate attributable to this organism was 0.26% during the study period. The duration of stay of cases was longer than that of controls. More cases than controls had ventilatory assistance. However, the predominant risk factor was emergency abdominal surgery. Before K. pneumoniae-CTX-1 was isolated, cases received quinolones and trimethoprim sulphamethoxazole more often than controls. However, only 15% of cases had received third generation cephalosporins while at the onset of K. pneumoniae-CTX-1 infection colonization, 32 patients were no longer being given antibiotics. The use of antibiotic prophylaxis by, for example, selective digestive tract decontamination should be considered in patients at high risk of infection.
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PMID:A case-control study of an outbreak of infections caused by Klebsiella pneumoniae strains producing CTX-1 (TEM-3) beta-lactamase. 167 72

The case records of all neonates admitted to the neonatal unit at Aga Khan University Hospital (Karachi) in a 30 month period (Nov. 86-April 89) were analysed. Of 60 neonates with confirmed sepsis, 33 (55%) had non-nosocomial infection (NNC) whereas 27 (45%) had nosocomial sepsis (NC). The most common organisms causing early-onset NNC sepsis were Klebsiella species (53%) and Escherichia coli (10%), whereas the organisms causing late-onset NNC sepsis included Salmonella parathypi (21%), Group A Streptococcus (21%), Escherichia coli (14%) and Pseudomonas species (14%). Klebsiella was the most common organism causing NC sepsis, others being Staphylococcus aureus (15%) and Serratia species (15%). The mortality in NC sepsis, early-onset and late onset NNC sepsis was 44%, 26% and 43%, respectively. Risk factors associated with NNC sepsis included low birthweight, prematurity and prolonged and complicated deliveries. There was a high incidence of drug resistance to ampicillin and gentamicin among gram-negative organisms causing sepsis (mean 67%).
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PMID:Neonatal sepsis in Pakistan. Presentation and pathogens. 186 74

To determine trends in the microbial etiology of nosocomial infections in the 1980s, surveillance data on the microbiology of documented nosocomial infection reported to the National Nosocomial Infections Surveillance System and from the University of Michigan Hospital were analyzed. Antimicrobial susceptibility data on selected pathogens from both sources were also reviewed. Overall, Escherichia coli decreased from 23% of infections in 1980 to 16% in 1986-1989, Klebsiella pneumoniae dropped from 7% to 5%, whereas coagulase negative staphylococci increased from 4% to 9% and Candida albicans increased from 2% to 5%. Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacter species and enterococci had minor increases, but antimicrobial resistant strains for these pathogens as well as coagulase-negative staphylococci were seen more frequently. In contrast to the 1970s, major shifts in the etiology of nosocomial infection have occurred in the decade of the 1980s. Taken as a whole, the shifts are away from more easily treated pathogens toward more resistant pathogens with fewer options for therapy. These shifts underscore the continued need for prevention and control to accompany new developments in therapy.
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PMID:Major trends in the microbial etiology of nosocomial infection. 192 95

This study was conducted prospectively on neonates admitted to the Neonatal Intensive Care Unit, Department of Child Health, Dr. Hasan Sadikin General Hospital Bandung, during the period of August 1, 1988 until January 31, 1989. The incidence rate was 51.6%. There were 9 males (56%) and 7 females (44%). Bacteriemia was the most common type of nosocomial infection and E. coli and Klebsiella pneumoniae were the most common etiology. All bacteriae were 100% sensitive to amikacin but 10% resistant to ampicillin and almost 100% sensitive to netilmycin and cefotaxime but almost 100% resistant to chloramphenicol, thiamphenicol and tobramycin. Based on this study, it is suggested that the treatment of nosocomial infection in the NICU should be initiated with amikacin or netilmycin or cefotaxime.
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PMID:Nosocomial infections in the Neonatal Intensive Care Unit Department of Child Health, Dr. Hasan Sadikin General Hospital, Bandung. 207 20

185 cases of bacteremia admitted at the internal medicine department of "C.S. Virgen de la Arrixaga" in Murcia from 1977 to 1986, were studied retrospectively. The common infection was significantly associated to Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus A group and Neisseria meningitidis and the nosocomial infection was associated to Klebsiella Pneumoniae, Serratia Marcescens y Pseudomonas aeruginosa, Staphylococcus epidermidis and Enterobacter. We did not find significant differences between the common and nosocomial infection caused by E. Coli and Proteus mirabilis. These factors were associated to an increase of mortality: age greater than 40 years, nosocomial infection, Pseudomonas aeruginosa, other associated rapidly lethal diseases, acute clinical state at the beginning of bacteremia, shock and non-correct antibiotic therapy.
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PMID:[Sepsis at an internal medicine department]. 210 94

At the end of 1989 the Division of Hospital Infection of the Central Public Health Laboratory completed five years of continuous surveillance of ciprofloxacin susceptibility amongst strains of Staphylococcus aureus and Pseudomonas aeruginosa. The strains studied were referred from many different UK laboratories for epidemiological or other typing. Between 1987 and 1989, referred cultures of coagulase-negative staphylococci, Klebsiella spp. and Enterobacter spp. were also examined. In total, 25,728 cultures from 254 different laboratories were included in the study, and S. aureus was the most common species amongst the survey material. Resistance to non-quinolone antimicrobials was common amongst the isolates. Over the study period there has been a gradual decline in the percentage of cultures received that were fully susceptible to ciprofloxacin and an increase in the number of laboratories referring strains with resistance or reduced sensitivity. Full susceptibility of S. aureus to ciprofloxacin has declined from 99.6% of 8981 cultures isolated in the two years before launch to 92.8% of 1968 cultures isolated during 1989. Amongst the coagulase-negative staphylococci there has been a similar decline in susceptibility from 99.4% of 658 cultures examined in 1987 to 92.6% of 433 cultures studied in 1989. There was also a decrease in susceptibility of P. aeruginosa isolates to ciprofloxacin from 98.6% of 2579 cultures isolated in 1985 and 1986 to 86.3% of 1152 cultures examined during 1989. Most of this decrease was attributable to the appearance of strains of intermediate susceptibility to ciprofloxacin (MICs 2 or 4 mg/l). Virtually no resistance to ciprofloxacin was observed amongst isolates of Klebsiella spp. and Enterobacter spp. referred between 1987 and 1989. The emergence of ciprofloxacin resistance, and by implication cross resistance to many of the other fluoroquinolones, is a worrying development and suggests that caution should be exerted in the use of these compounds for the treatment of infections due to staphylococci and P. aeruginosa.
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PMID:Susceptibility to ciprofloxacin of nosocomial gram-negative bacteria and staphylococci isolated in the UK. 212 70

The in-vitro activity of ceftibuten was compared with cefuroxime and cefadroxil against 475 clinically-significant, epidemiologically-distinct isolates of Gram-negative bacilli: 170 from blood, 212 from urine and 93 from a supplementary collection of multiply-resistant strains known to have resistance plasmids, to have caused sporadic or epidemic nosocomial infection, or both. Ceftibuten MICs ranged from 0.003 to greater than 32 mg/l, with a modal MIC of 0.01 mg/l: 95% of all isolates had ceftibuten MIC values of less than or equal to 8 mg/l, the sensitivity breakpoint suggested by the manufacturer. Ninety per cent of isolates had MICs of less than or equal to 1 mg/l and 49% had MICs of less than or equal to 0.03 mg/l. All isolates of Klebsiella, Serratia, Proteus and Providencia spp., and Morganella morganii had MIC values of 8 mg/l or less. Only two of 124 isolates of Escherichia coli tested, and only one of 23 Citrobacter spp., had MICs of greater than 8 mg/l (16, 16 and greater than 32 mg/l respectively). Resistance MIC greater than 16 mg/l) was more frequent among Enterobacter and Acinetobacter spp. Thirteen of 52 Enterobacter spp., and seven of 18 Acinetobacter calcoaceticus had MICs of at least 32 mg/l. MIC ranges, modal MICs and MIC90s indicated that ceftibuten was, with the exception of only two strains, consistently more active in-vitro than cefuroxime, which was in turn more active than cefadroxil.
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PMID:The in-vitro activity of ceftibuten against 475 clinical isolates of gram-negative bacilli, compared with cefuroxime and cefadroxil. 232


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