Ceftriaxone-resistant Klebsiella pneumoniae: Inpatient





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Published on Jul 22, 2011

Klebsiella pneumoniae is a member of the Enterobacteriacae family, which along with E. coli accounts for the vast majority of hospital and community-acquired urinary tract infections (UTIs). It is also a frequent cause of nosocomial (health care--associated) bloodstream infections and community-acquired pneumonia among alcoholics.

This video shows the trends in inpatient K. pneumoniae resistance to ceftriaxone, one of several broad-spectrum cephalosporin antibiotics with high intrinsic activity against this pathogen. The regional and national patterns are broadly similar to those for outpatient samples.

The data suggest that resistance to ceftriaxone remains relatively stable until 2004. In the second half of the decade, resistance begins to climb sharply, starting in New England and spreading along the East Coast and to the interior of the country. Although levels remain stable in East South Central, they increase sharply in some East Coast states: relative to 2003 levels, by 2009 resistance rates have tripled in the Mid-Atlantic and quintupled in the South Atlantic.

The increase in resistance is worrisome because it could be a proxy for the emergence and spread of Enterobacteriaceae strains producing extended-spectrum β-lactamase (ESBL). ESBLs are bacterial enzymes that confer resistance to many highly effective antibiotic classes, particularly cephalosporins like ceftriaxone. ESBL-producing K. pneumoniae strains are increasingly common in the healthcare setting in parts of the Northeast, and there is now evidence of their dissemination in the community. ESBL infections are still susceptible to the newer and more expensive antibiotics of the carbapenem class. However, newer types of beta-lactamase enzymes are diminishing the effectiveness of these last-resort treatments and posing an emerging threat to public health.

The national average resistance level for the sample was 5.7%, rising from 3.1% in 2000 to 7.7% in 2009.

The sample consists of 258,792 inpatient isolates tested for ceftriaxone resistance. Data are not available from the following states: AR (2008--2009), CO (2006--2009), GA (2007--2009), IA (2000--2003), IN (2007--2009), KY (2007--2009), MA (2000--2003), NE (2003--2004), NV (2009), RI (2000--2004), UT (2007--2009), CT, NH, MS, MT, SD and WY.


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