Incidence rate and detection of Klebsiella pneumoniae producing extended-spectrum beta-lactamase in a department of anaesthesiology and resuscitation, Ceske Budejovice
Abstract number: 902_p1864
Klebsiella pneumoniae is the first pathogen to be found producing extended-spectrum beta-lactamases (ESBLs), mainly due to TEM and SHV enzymes gene mutation. The mutation development is facilitated by frequent empiric use of third generation cephalosporins in the ICU setting.
To detect the presence of ESBL, we use Double Disc Synergy Test, utilising the following discs: amoxicillin/clavulanic acid (AMC)-disc contents 20/10 mg, ceftazidime (CTZ) 30 mg, cefpodoxime (CPD) 10 mg, aztreonam (AZT) 30 mg. The test is based upon the susceptibility of extended spectrum beta-lactamases to clavulanic acid. A positive result is manifested by characteristic extension of inhibition zone between the discs with AMC and a third generation cephalosporin (or AZT). The test is performed in K. pneumoniae strains that show intermediate susceptibility or resistance to second and third generation cephalosporins.
From 2000 till 2003, the number of patients who tested positive for ESBL producing strains of K. pneumoniae dropped from 80 (17%) down to 2 (0.4%). Concurrently, the use of third generation cephalosporins (ceftazidime, cefotaxime, ceftriaxone, cefoperazone) was reduced from 3.5 g down to 2 g per one hospitalised patient. A certain contribution should also be attributed to a more strict adherence to hygienic guidelines (patient isolation, handwashing, single-use devices, etc.).
The incidence rate of multiresistant, ESBL-producing strains of K. pneumoniae may be mitigated by controlled broad-spectrum antibiotic use and a stricter adherence to hygienic guidelines."
|Session name:||XXIst ISTH Congress|
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