@article{3141825,
    title = "Outbreak of infections due to KPC-2-producing Klebsiella pneumoniae in a
hospital in Crete (Greece)",
    author = "Maltezou, H. C. and Giakkoupi, P. and Maragos, A. and Bolikas, M. and and Raftopoulos, V. and Papahatzaki, H. and Vrouhos, G. and Liakou, V. and and Vatopoulos, A. C.",
    journal = "Journal of Infection",
    year = "2009",
    volume = "58",
    number = "3",
    pages = "213-219",
    publisher = "W B SAUNDERS CO LTD",
    issn = "0163-4453",
    doi = "10.1016/j.jinf.2009.01.010",
    keywords = "KPC; Carbapenemase; Resistance; Nosocomial outbreak; Klebsiella
pneumoniae; Tigecycline; Colistin",
    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. (C) 2009
The British Infection Society. Published by Elsevier Ltd. All rights
reserved."
}