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Webster, D. P., Young, B. C., Morton, R., Collyer, D., Batchelor, B., Turton, J. F., Maharjan, S., Livermore, D. M. 
ORCID: https://orcid.org/0000-0002-9856-3703, Bejon, P., Cookson, B. D. and Bowler, I. C. J. W.
(2011)
Impact of a clonal outbreak of extended-spectrum β-lactamase-producing Klebsiella Pneumoniae in the development and evolution of bloodstream infections by K. pneumoniae and Escherichia coli: An 11 year experience in Oxfordshire, UK.
Journal of Antimicrobial Chemotherapy, 66 (9).
pp. 2126-2135.
ISSN 0305-7453
Abstract
Objectives: The objectives of this study were: (i) to describe an outbreak of multidrug-resistant Klebsiella pneumoniae in our population; (ii) to identify the potential source of this outbreak by examining antibiotic resistance trends in urocultures; (iii) to evaluate the contribution of this outbreak to resistance patterns over time in the two commonest Gram-negative blood culture isolates, namely K. pneumoniae and Escherichia coli; and (iv) to assess risk factors for multidrug resistance and the impact of this resistance on mortality and length of stay. Methods: We searched Microbiology and Patient Administration Service databases retrospectively and describe resistance trends in E. coli and K. pneumoniae bloodstream infections (BSIs) in Oxfordshire, UK, over an 11 year period. Results: An outbreak of a multidrug-resistant, CTX-M-15 extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae clone was identified and shown by multilocus sequence typing to belong to a novel sequence type designated ST490. This was associated with a sporadic change in resistance rates in K. pneumoniae BSIs with rates of multidrug resistance (defined as resistance to three or more antibiotic classes) reaching 40%. A case–control study showed prior antibiotic exposure as a risk factor for infection with this organism. During the same time period, rates of ESBL-producing Klebsiella spp. isolated from urocultures increased from 0.5% to almost 6%. By contrast, the rate of multidrug resistance in E. coli rose more steadily from 0% in 2000 to 10% in 2010. Conclusions: Changes in resistance rates may be associated with outbreaks of resistant clones in K. pneumoniae. Changing resistance patterns may affect important health economic issues such as length of stay.
| Item Type: | Article |
|---|---|
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023) Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health |
| Depositing User: | Sophie Buckingham |
| Date Deposited: | 05 Mar 2013 10:55 |
| Last Modified: | 11 Jan 2024 01:20 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/41705 |
| DOI: | 10.1093/jac/dkr246 |
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