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A case-control study of risk factors for urinary acquisition of Klebsiella pneumoniae producing CTX-M-15 in an outbreak situation in Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research center.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
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2010 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 42, no 6-7, 439-444 p.Article in journal (Refereed) Published
Abstract [en]

A retrospective case-control study was initiated at Uppsala University Hospital in 2006 during a major outbreak caused by a Klebsiella pneumoniae strain producing CTX-M-15. To identify risk factors associated with acquisition of the outbreak strain in the urinary tract, 52 case patients with a urine culture positive for the outbreak strain between 1 May and 31 December 2005 were enrolled. Case patients were matched 1:2 with concurrently hospitalized control patients with significant growth of susceptible Escherichia coli in a urine sample. Conditional logistic regression analyses identified hospital stay >/=9 days (odds ratio (OR) 18.8, 95% confidence interval (CI) 5.74-61.2), nasogastric feeding tube (OR 18.0, 95% CI 2.28-142) and diarrhoea (OR 9.62, 95% CI 3.30-28.1) as risk factors with high ORs. The odds of previous use of cephalosporins were 7.58 (95% CI 3.13-18.4) times higher in case patients compared with the controls. Several multivariable models were evaluated to reduce bias from confounding. These models identified prolonged period of hospitalization, diarrhoea, malignancy and antibiotic use as the most important risk factors for acquisition of the outbreak strain, factors that are often found in elderly patients with a poor functional status.

Place, publisher, year, edition, pages
2010. Vol. 42, no 6-7, 439-444 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-123911DOI: 10.3109/00365540903582434ISI: 000279896500006PubMedID: 20180680OAI: oai:DiVA.org:uu-123911DiVA: diva2:316250
Available from: 2010-04-30 Created: 2010-04-30 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Enterobacteriaceae Producing Extended-Spectrum Beta-Lactamases: Aspects of Detection, Epidemiology and Control
Open this publication in new window or tab >>Enterobacteriaceae Producing Extended-Spectrum Beta-Lactamases: Aspects of Detection, Epidemiology and Control
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Enterobacteriaceae belong to the normal enteric flora in humans and may cause infections. Escherichia coli is the leading urinary tract pathogen with septicaemic potential, whereas Klebsiella pneumoniae causes opportunistic infections and often outbreaks in hospital settings. Beta-lactams are the first choice for treatment of infections caused by Enterobacteriaceae, and might be destroyed by extended-spectrum beta-lactamases, ESBLs. ESBLs hydrolyse all beta-lactams except cephamycin and carbapenems, and constitute a large heterogeneous group of enzymes with different origins. The phenotypic and molecular characteristics of a K. pneumoniae strain causing a major outbreak at Uppsala University Hospital between 2005 and 2008 were described. The strain was multiresistant and produced CTM-M-15, a common ESBL type in Europe. Due to the lack of obvious epidemiological links between patients, a case-control study was performed, which identified risk factors for the acquisition of the outbreak strain in urine cultures. The complex chain of transmission facilitated by patient overcrowding and the interventions applied to curb the outbreak, was revealed in the subsequent study. In the final study, the genetic background of the observed increase in ESBL-producing E. coli isolates during the K. pneumoniae outbreak was explored. The utility of six typing methods in epidemiological investigations of a local outbreak with ESBL-producing E. coli was compared. The increase of ESBL-producing E. coli isolates was not secondary to the K. pneumoniae outbreak. Twentytwo per cent belonged to the epidemic O25b-ST131 clone and only a limited number of infections were caused by nosocomial transmission. ESBL-producing Enterobacteriaceae are a challenge to clinical microbiology laboratories and infection control teams. To investigate their dissemination, typing methods need to be continuously adapted to the current situation. Proper hand disinfection and structural key problems such as over-crowding, under-staffing, lack of single rooms and bathrooms must be adressed to limit transmission.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 57 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 610
Keyword
Extended-spectrum beta-lactamase, ESBL, pulse-field gel elctrophoresis, typing methods, infection control, typningsmetoder, vårdhygien
National Category
Microbiology in the medical area
Research subject
Clinical Bacteriology
Identifiers
urn:nbn:se:uu:diva-131901 (URN)978-91-554-7922-0 (ISBN)
Public defence
2010-12-03, Hörsalen, Klinisk mikrobiologi, Dag Hammarskölds väg 17, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-11-12 Created: 2010-10-09 Last updated: 2011-01-13Bibliographically approved

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