Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-24T09:16:58.893Z Has data issue: false hasContentIssue false
  • English
  • Français

The Epidemiology of Nosocomial Infections Caused by Klebsiella pneumoniae

Published online by Cambridge University Press:  02 January 2015

William R. Jarvis ,
Van P. Munn ,
Anita K. Highsmith ,
David H. Culver  and
James M. Hughes
William R. Jarvis*
Affiliation:
Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
Van P. Munn
Affiliation:
Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
Anita K. Highsmith
Affiliation:
Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
David H. Culver
Affiliation:
Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
James M. Hughes
Affiliation:
Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
*
Surveillance and Prevention Branch, Hospital Infections Program, Centers for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333
Get access Rights & Permissions [Opens in a new window]

Abstract

Klebsiella pneumoniae causes serious epidemic and endemic nosocomial infections. We conducted a literature review to characterize the epidemiology of epidemic K. pneumoniae outbreaks. Eighty percent of the outbreaks (20/25) involved infections of the bloodstream or urinary tract. Person-to-person spread was the most common mode of transmission, and nearly 50% of the outbreaks occurred in neonatal intensive care units. No one serotype predominated, and no association was found between serotype and either the site of infection or the antimicrobial susceptibility pattern.

We used data reported to the Centers for Disease Control (CDC) by hospitals participating in the National Nosocomial Infections Study (NNIS) to describe the epidemiology of endemic K. pneumoniae infections. In die 8-year period from 1975 through 1982 the nosocomial K. pneumoniae infection rate was 16.7 infections per 10,000 patients discharged. The rate of infection at medical school-affiliated hospitals was significantly greater than at nonaffiliated hospitals; furthermore, the rate of infection at large affiliated hospitals was greater than at small affiliated hospitals. The rate of infection varied by service, with the highest rate found on the medicine service. During the 8-year period, 184 deaths were caused by nosocomial K. pneumoniae infections (184 deaths/16,969 infections, case-fatality ratio 1.1%), with higher ratios in pediatrics (5%) where there was a 12% mortality in children infected with an aminoglycoside-resistant strain.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 6 , Issue 2 , February 1985 , pp. 68 - 74
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1985

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. O'Callaghan, RJ, Rousset, KM, Harkess, NK, et al: Analysis of increasing antibiotic resistance of Klebsiella pneumoniae relative to changes in chemotherapy. J Infect Dis 1978; 138:293–298.CrossRefGoogle ScholarPubMed
2. Hable, KA, Matsen, JM, Wheeler, DJ, et al: Klebsiella type 33 septicemia in an infant intensive care unit. J Pediatr 1972; 80:920–924.CrossRefGoogle Scholar
3. Eidelman, AI, Reynolds, J: Gentamicin-resistant Klebsiella infections in a neonatal intensive care unit. Am J Dis Child 1978; 132:421–422.Google Scholar
4. Weil, AJ, Ramchand, S, Arias, ME: Nosocomial infections with Klebsiella type 25. N Engl J Med 1966; 275:17–22.CrossRefGoogle ScholarPubMed
5. Martin, CM, Ikari, NS, Zimmerman, J, et al: A virulent nosocomial Klebsiella with a transferable R factor for gentamicin: Emergence and suppression. J Infect Dis 1971; 124:S24–29.CrossRefGoogle Scholar
6. Noriega, ER, Leibowitz, RE, Richmond, AS, et al: Nosocomial infection caused by gentamicin-resistant, streptomycin-sensitive Klebsiella . J Infect Dis 1975; 131:S45–50.CrossRefGoogle ScholarPubMed
7. Cichon, MJ, Craig, CP, Sargent, J, et al: Nosocomial Klebsiella infections in an intensive care nursery. South Med J 1977; 70:33–35.CrossRefGoogle Scholar
8. Hill, HR, Hunt, CE, Matsen, JM: Nosocomial colonization with Klebsiella, type 26, in a neonatal intensive-care unit associated with an outbreak of sepsis, meningitis, and necrotizing enterocolitis. J Pediatr 1974; 85:415–419.CrossRefGoogle Scholar
9. Adler, JL, Shulman, JA, Terry, PM, et al: Nosocomial colonization with kanamycin-resistant Klebsiella pneumoniae, types 2 and 11, in a premature nursery. J Pediatr 1970; 77:376–385.CrossRefGoogle Scholar
10. Markowitz, SM, Veazey, JM, Macrina, FL, et al: Sequential outbreaks of infection due to Klebsiella pneumoniae in a neonatal intensive care unit: Implication of a conjunctive R plasmid. J Infect Dis 1980; 142(1): 106–112.CrossRefGoogle Scholar
11. Morse, LJ, Williams, HL, Green, FP, et al: Septicemia due to Klebsiella pneumoniae originating from a hand-cream dispenser. N Engl J Med 1967; 277:472–473.CrossRefGoogle ScholarPubMed
12. Hardy, DJ, Legeal, RJ, O'Callaghan, RJ : Klebsiella neonatal infections: Mechanism of broadening aminoglycoside resistance. Antimicrob Agents Chemother 1980; 18:542–548.CrossRefGoogle ScholarPubMed
13. Schaberg, DR, Weinstein, RA, Stamm, WE: Epidemics of nosocomial urinary tract infection caused by multiply resistant gram-negative bacilli: Epidemiology and control. J Infect Dis 1976; 133:363–366.CrossRefGoogle ScholarPubMed
14. Mertz, JJ, Scharer, L, McClement, JH: A hospital outbreak of Klebsiella pneumoniae from inhalation therapy with contaminated aerosol solutions. Am Rev Respir Dis 1967; 95:454–460.Google Scholar
15. Donowitz, LG, Marsik, FJ, Fisher, KA, et al: Contaminated breast milk: A source of Klebsiella bacteremia in a newborn intensive care unit. Rev Infect Dis 1981; 3:716–720.Google Scholar
16. McKee, KT, Cotton, RB, Stratton, CW, et al: Nursery epidemic due to multiply-resistant Klebsiella pneumoniae: Epidemiologic setting and impact on perinatal health care delivery. Infect Control 1982; 3:150–156.Google Scholar
17. Ross, BS, Peter, G, Dempsey, JM, et al: Klebsiella pneumoniae nosocomial epidemic in an intensive care nursery due to contaminated intravenous fluid. Am J Dis Child 1977; 131:712.Google Scholar
18. Thiemke, WA, Nathan, DM: Simultaneous nosocomial outbreaks caused by multiply resistant Klebsiella pneumoniae types 2 and 30. J Clin Microbiol 1978; 8:769–771.Google Scholar
19. Gerding, DN, Buxton, AE, Hughes, RA, et al: Nosocomial multiply resistant Klebsiella pneumoniae: Epidemiology of an outbreak of apparent index case origin. Antimicrob Agents Chemother 1979; 15:608–615.CrossRefGoogle ScholarPubMed
20. Mayhall, CG, Lamb, VA, Bitar, CM, et al: Nosocomial Klebsiella infection in a neonatal unit: Identification of risk factors for gastrointestinal colonization. Infect Control 1980; 1:239–246.CrossRefGoogle Scholar
21. Greenhood, GP, Highsmith, AK, Allen, JR, et al: Klebsiella pneumoniae pseudobacteremia due to cross-contamination of a radiometric blood culture analyzer. Infect Control 1981; 2:460–465.CrossRefGoogle ScholarPubMed
22. Jarvis, WR, Highsmith, AK, Allen, JR, et al: Polymicrobial bacteremia associated with lipid emulsion in a neonatal intensive care unit. Pediatr Infect Dis 1983; 2:203–208.CrossRefGoogle Scholar
23. Montgomerie, JZ: Epidemiology of Klebsiella and hospital-associated infections. Rev Infect Dis 1979; 1:736–753.CrossRefGoogle ScholarPubMed
24. McKee, KT, Melly, MA, Greene, HL, et al: Gram-negative bacillary sepsis associated with use of lipid emulsion in parenteral nutrition. Am J Dis Child 1979; 133:649–650.Google Scholar
25. Seiden, R, Lee, S, Wang, WLL, et al: Nosocomial Klebsiella infections: Intestinal colonization as a reservoir. Ann Intern Med 1971; 74:657–664.Google Scholar
26. Knittle, MA, Eitzman, DV, Baer, H: Role of hand contamination of personnel in the epidemiology of gram-negative nosocomial infections. J Pediatr 1975; 86:433–437.Google Scholar
27. Davis, TJ, Matsen, JM: Prevalence and characteristics of Klebsiella species: Relation to association with a hospital environment. J Infect Dis 1974; 130:402–405.CrossRefGoogle ScholarPubMed
28. Cooke, EM, Brayson, JC, Edmondson, AS, et al: An investigation into the incidence and sources of Klebsiella infections in hospital patients. J Hyg 1979; 82:473–480.CrossRefGoogle ScholarPubMed
29. Haverkorn, MJ, Michel, MF: Nosocomial Klebsiella: Transfer in a hospital ward. J Hyg 1979; 82:195–205.Google Scholar
30. Haverkorn, ML, Michel, MF: Nosocomial Klebsiella: Colonization of hospitalized patients. Hyg 1979; 82:177–193.Google Scholar
31. Taplin, D, Mertz, PM: Flower vases in hospitals as reservoirs of pathogens. Lancet 1973; 2:1279–1281.Google Scholar
32. Mangi, RJ, Andriole, VT: Contaminated stethoscopes: A potential source of nosocomial infections. Yale J Biol Med 1972; 45:600–604.Google ScholarPubMed
33. Casewell, M, Phillips, I: Food as a source of Klebsiella species for colonization and infection of intensive care patients. J Clin Pathol 1978; 31:845–849.CrossRefGoogle ScholarPubMed
34. Shooter, RA, Faiers, MC, Cooke, EM, et al: Isolation of Escherichia coli, Pseudomonas aeruginosa, and Klebsiella from food in hospitals, canteens, and schools. Lancet 1971; 1:390–392.Google Scholar
35. Adams, BG, Marrie, TJ: Hand carriage of aerobic gram-negative rods by health care personnel. J Hyg 1982; 89:23–31.Google Scholar
36. Adams, BG, Marrie, TJ: Hand carriage of aerobic gram-negative rods may not be transient. J Hyg 1982; 89:33–46.Google Scholar
37. Casewell, M, Phillips, I: Hands as route of transmission for Klebsiella species. Br MedJ 1977;2:1315–1317.Google Scholar
38. Goldmann, DA, Leclair, J, Macone, A: Bacterial colonization of neonates admitted to an intensive care environment. J Pediatr 1978; 93:288–293.Google Scholar
39. Smith, SM, Gigor, JT, Eng, RHK: Epidemiology of Klebsiella antibiotic resistance and serotypes. J Clin Microbiol 1982; 16:868–873.CrossRefGoogle ScholarPubMed
40. Martin, WJ, Yu, PKW, Washington, JA: Epidemiologic significance of Klebsiella pneumoniae . Mayo Clin Proc 1971; 46:785–793.Google Scholar
41. Courtney, M, Miller, JR, Summersgill, J, et al: R-factor responsible for an outbreak of multiply antibiotic-resistant Klebsiella pneumoniae . Antimicrob Agents Chemother 1980; 18(6):926–929.Google Scholar
42. Hughes, JM, Culver, DH, White, JW, et al: Nosocomial Infections Surveillance, 1980-1982. MMWR CDC Surveill Summ 1983; 32(suppl):1–17.Google Scholar
43. Epidemiology of Klebsiella infections. Lancet 1971; 1:416–417.Google Scholar