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Title: Outbreak of infections due to kpc-2-producing klebsiella pneumoniae in a hospital in Crete (Greece)
Authors: Maltezou, Helena C. 
Giakkoupi, Panagiota 
Maragos, Antonios 
Bolikas, M. 
Raftopoulos, Vasilios 
Papahatzaki, H. 
Vrouhos, G. 
Liakou, Vassiliki 
Vatopoulos, Alkiviadis C. 
Major Field of Science: Medical and Health Sciences
Field Category: Clinical Medicine
Keywords: KPC;Carbapenemase;Resistance;Nosocomial outbreak;Klebsiella pneumoniae;Tigecycline;Colistin
Issue Date: Mar-2009
Source: Journal of Infection, 2009, vol. 58, no. 3, pp. 213-219
Volume: 58
Issue: 3
Start page: 213
End page: 219
Journal: Journal of Infection 
Abstract: Starting in May 2007, an ongoing outbreak of infections due to carbapenem resistant KPC-2-producing Klebsiella pneumoniae occurred in a tertiary care hospital in Crete (Greece). The outbreak involved 22 patients, none of whom had travelled in a country with known high prevalence of such isolates. KPC-producing K. pneumoniae strains were mainly isolated from patients admitted in the Intensive Care Unit, on mechanical ventilation, with prolonged hospitalization, prolonged administration of antibiotics, and prolonged administration of carbapenems. Clinical diagnoses were: pneumonia (62% of cases), surgical site infection (19%), bacteremia (9.5%), urinary tract infection (4.7%), and peritonitis (4.7%). Overall, 61 KPC-producing K. pneumoniae isolates were recovered, mainly from the respiratory tract (59.1%), catheter tip (22.7%), surgical site (18.2%), and blood (18.2%). Among 16 patients for whom therapeutic data were available, 14 (87.5%) were treated with a combination of colistin and/or tigecycline and/or garamycin. Clinical failure was noted in 22.2% of 18 patients available for assessment of clinical outcome, and microbiologic failure in 87.5% of 8 patients available for assessment of microbiologic outcome. In conclusion, an outbreak of KPC-producing K. pneumoniae infections has occurred in a tertiary care hospital in Greece, with significant associated morbidity and mortality. Prospective studies are required to evaluate the available therapeutic options for these infections. Our efforts should focus on rational use of available antibiotics, enhancement of infection control measures, and implementation of active antibiotic resistance surveillance.
ISSN: 0163-4453
DOI: 10.1016/j.jinf.2009.01.010
Rights: © Elsevier
Type: Article
Affiliation: Hellenic Centre for Disease Control and Prevention 
Affiliation : Hellenic Centre for Disease Control and Prevention 
National School of Public Health 
Venizeleio General Hospital 
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