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Published on: February 9, 2011
A hospital epidemic caused by gentamicin-resistant Klebsiella aerogenes
Abstract:
In the 15 months, February 1976 to April 1977, more than 241 patients became colonized with a strain of Klebsiella aerogenes, capsular serotype K2, resistant to most antibiotics. Urinary tract infection was the most common clinical manifestation but bacteraemia and, occasionally, infections of other sites were encountered. The main reservoir of the epidemic klebsiella was the gut, urine and skin of colonized patients. Gut carriage among staff was very uncommon. The most susceptible patients were elderly males, with debilitating illnesses and urinary tract abnormalities, especially if they were catheterized or receiving antibiotics. Likely vehicles for spread were the hands of staff, and contaminated bedpans and urinals. Control measures were directed at these factors. At the end of April 1977 no new cases had occurred for 3 months in the ward in which the outbreak began, and which had been the main focus of infection, and only 5 patients in the affected hospitals were known to be colonized by the epidemic klebsiella.
Insights
An antibiotic-resistant Klebsiella aerogenes (K2) outbreak affected over 241 patients, primarily causing urinary tract infections. Control measures targeting staff hygiene and equipment effectively halted the spread.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- A significant outbreak of antibiotic-resistant Klebsiella aerogenes, specifically serotype K2, occurred between February 1976 and April 1977.
- This resistant strain led to colonization in over 241 patients, manifesting primarily as urinary tract infections, but also causing bacteremia and other site infections.
Purpose of the Study:
- To investigate the epidemiology of an outbreak caused by antibiotic-resistant Klebsiella aerogenes K2.
- To identify patient susceptibility factors, reservoirs, and transmission routes.
- To evaluate the effectiveness of control measures implemented during the outbreak.
Main Methods:
- Retrospective analysis of patient colonization and infection data over a 15-month period.
- Identification of the causative agent as Klebsiella aerogenes K2 with multi-drug resistance.
- Epidemiological investigation to determine risk factors, transmission vectors, and reservoir.
Main Results:
- The primary reservoir for the epidemic Klebsiella was the gut, urine, and skin of colonized patients; staff gut carriage was minimal.
- Elderly males with comorbidities, urinary tract abnormalities, catheterization, or antibiotic use were most susceptible.
- Hands of healthcare staff and contaminated bedpans/urinals were identified as likely transmission vehicles.
Conclusions:
- Effective control measures targeting staff hygiene and environmental disinfection successfully contained the Klebsiella aerogenes K2 outbreak.
- No new cases were reported in the initial outbreak ward for 3 months post-intervention, indicating successful control.
- The study highlights the importance of infection control practices in preventing the spread of antibiotic-resistant organisms in healthcare settings.
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