An Endemic Caused by Multiresistant Klebsiella in An Urological Unit

Abstract

A long-term endemic caused by Klebsiella pneu-moniae occurred in the period 1966 to 1970 among patients in an urological unit. The multiresistant bacteria which were uniformly resistant to sulfonamides, ampicillin, and tetracyclines, were responsible for asymptomatic significant bacteriuria or overt urinary tract infection in 93 patients during an observation period covering one year (1967). Septicemia developed in 12 patients and 6 of the patients eventually succumbed. The endemic was provoked by two different types of Klebsiella: a chloramphenicol-sensitive and kanamycin-resistant one of capsular type 35, and a chloramphenicol-resistant and kanamycin-sensitive one of capsular type 7. Each of the two serotypes possessed their distinct phage pattern. Aseptic as well as antiseptic procedures were reviewed, but no flaws of any importance were disclosed either in the operating theatres or in the wards. A search for the Klebsiella throughout the environment was futile except in one locality, namely in a soiled utility room where the air was found to contain the organism. Thus, the pathways and vectors of the cross-infection could unfortunately not be established, but the utility rooms might reasonably be suspected to be a reservoir of the menacing hospital invader: Klebsiella.