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Sequential emergence of multi-resistant Klebsiella pneumoniae in Bahrain
M R Wallace1, A P Johnson, M Daniel
1Department of Internal Medicine, Naval Medical Center, San Diego, California 92134-5000, USA.
Abstract:
During the mid-1980s, nosocomial infections due to aminoglycoside-resistant Klebsiella pneumonia were prevalent in the intensive care unit (ICU) of the Salamanya Medical Centre, Bahrain. In an attempt to control the spread of such organisms, the third-generation cephalosporins were introduced in early 1987. Subsequently there was a marked increase in the incidence of cephalosporin resistance among Klebsiella spp. isolated in the ICU. In 1990, over 60% of Klebsiella isolates were resistant to both cephalosporins and aminoglycosides. Cephalosporin resistance was due to production of extended-spectrum beta-lactamases encoded on the same plasmid as aminoglycoside resistance. The incidence of cephalosporin resistance declined during 1991-1992, which was coincident with severe restrictions on the use of third-generation cephalosporins and the preferential use of ciprofloxacin and imipenem for nosocomial klebsiella infections. Sequential overuse of aminoglycosides and cephalosporins for nosocomial klebsiella infection may select for organisms resistant to both classes of antibiotics.
Insights
Overuse of antibiotics like aminoglycosides and cephalosporins for Klebsiella pneumoniae infections can lead to multidrug-resistant strains. Restricting cephalosporin use helped decrease resistance, highlighting the importance of judicious antibiotic stewardship.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Nosocomial infections caused by aminoglycoside-resistant Klebsiella pneumoniae were common in the ICU.
- Introduction of third-generation cephalosporins in 1987 led to increased cephalosporin resistance in Klebsiella spp.
Purpose of the Study:
- To investigate the emergence and decline of cephalosporin resistance in Klebsiella spp. in an ICU setting.
- To understand the relationship between antibiotic use patterns and the development of multidrug resistance.
Main Methods:
- Retrospective analysis of Klebsiella isolates and antibiotic usage data from an ICU.
- Identification of resistance mechanisms, including extended-spectrum beta-lactamase (ESBL) production.
- Correlation of resistance trends with changes in antibiotic prescribing practices.
Main Results:
- By 1990, over 60% of Klebsiella isolates showed resistance to both cephalosporins and aminoglycosides.
- Cephalosporin resistance was linked to ESBLs encoded on plasmids also carrying aminoglycoside resistance genes.
- A decline in cephalosporin resistance occurred during 1991-1992 following restrictions on third-generation cephalosporin use and increased use of ciprofloxacin and imipenem.
Conclusions:
- Sequential overuse of aminoglycosides and cephalosporins can select for bacteria resistant to both antibiotic classes.
- Judicious antibiotic stewardship, including restricting the use of broad-spectrum agents, is crucial for controlling multidrug-resistant infections.
- The findings underscore the dynamic interplay between antibiotic selection pressure and the evolution of antimicrobial resistance in healthcare settings.