Epidemiologic characteristics of Klebsiella pneumoniae isolates in ventilator-associated pneumonia in intensive care units

Abstract

Background: Klebsiella pneumoniae is a common pathogen that causes ventilator-associated pneumonia (VAP) in intensive care units (ICUs). Strain typing is a useful tool in tracking the spread of these infections. Primary objective was to study the different K. pneumoniae strains causing VAP in Anesthesia ICUs, Zagazig University Hospitals, Egypt. Secondary objective was to determine the role of healthcare workers (HCWs) and ICU environment in the transmission of these strains. Methods: Endotracheal aspirates of 60 VAP patients were collected. Surveillance samples were collected from the HCWs and the ICU environment. Antibiogram typing and enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) were used for comparison of the isolates from the surveillance samples and VAP patients. Antibiogram showed five antibiotic susceptibility patterns that were designated A1-A5. Results: All five patterns showed multidrug resistance (MDR) as strains were resistant to five or six antibiotics. ERIC-PCR yielded one to five amplification bands. All the isolates were typable by this method. Eight ERIC patterns were obtained ERIC(I)-ERIC(VIII). ERIC-PCR typing method gave higher discriminatory index (D) (0.7557) than antibiogram (0.6035). Sharing of certain ERIC patterns among patient strains may be explained by horizontal transmission from patient to another patient, probably from the hands of HCWs or environmental sources. Conclusion: K.pneumoniae is the most dominant member of pathogens in Zagazig University hospitals anesthesia ICUs. Throats and hands of HCWs are possible sources of pathogen transmission to the ICU patients. Surfaces with hand contact of the medical staff are often contaminated and may serve as vectors for cross transmission.