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Emergence of gentamicin-resistant Klebsiella in a general hospital

R P Rennie, I B Duncan

    Antimicrobial Agents and Chemotherapy
    |February 1, 1977
    PubMed

    Insights

    Gentamicin resistance in Klebsiella emerged after 7 years of use. R-factor mediated resistance, often co-transferring other antibiotic resistances, was observed in multiple strains, though all remained susceptible to amikacin and netilmicin.

    Area of Science:

    • Medical Microbiology
    • Infectious Diseases
    • Antimicrobial Resistance

    Background:

    • Gentamicin has been widely used in hospitals for over seven years.
    • The emergence of gentamicin-resistant Klebsiella strains was observed after a significant period of gentamicin use.
    • Klebsiella infections pose a significant challenge in healthcare settings, particularly in patients with indwelling devices.

    Purpose of the Study:

    • To investigate the emergence and characteristics of gentamicin-resistant Klebsiella strains in a general hospital.
    • To identify the mechanisms of resistance and the epidemiological spread of these resistant strains.
    • To assess the susceptibility patterns of resistant Klebsiella to other available antibiotics.

    Main Methods:

    • Isolation and characterization of Klebsiella strains from patients between 1974 and 1975.
    • Determination of antibiotic resistance profiles, including R-factor mediated resistance.
    • Epidemiological investigation of strain transmission, particularly in patients with urinary catheters.
    • Antimicrobial susceptibility testing against various antibiotics, including amikacin and netilmicin.

    Main Results:

    • Nine distinct gentamicin-resistant Klebsiella serobiotypes were isolated from 35 patients.
    • The initial resistant strain exhibited R-factor mediated gentamicin resistance and spread via patient-to-patient transmission, primarily in catheterized patients.
    • This strain appeared to lose its resistance transfer capability after infecting five patients.
    • Other resistant strains had limited persistence and patient involvement.
    • Four of these strains, along with the initial strain, co-transferred resistance to kanamycin, neomycin, and tobramycin.
    • All isolated gentamicin-resistant Klebsiella strains remained susceptible to amikacin and netilmicin.

    Conclusions:

    • The emergence of gentamicin resistance in Klebsiella is linked to R-factor mediated mechanisms.
    • Hospital-acquired infections with resistant Klebsiella can spread through patient-to-patient contact, especially in vulnerable populations.
    • The emergence of resistance did not significantly impact the effectiveness of newer antibiotics like amikacin and netilmicin against these strains.
    • Understanding resistance mechanisms and transmission dynamics is crucial for infection control strategies.

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