Thompson W, Romance L, Bialkowska-Hobrazanska H, Rennie R P, Ashton F, Nicolle L E
Department of Medicine, University of Manitoba, Winnipeg, Canada.
Infect Control Hosp Epidemiol. 1993 Apr;14(4):203-10. doi: 10.1086/646716.
To identify factors associated with an increased occurrence of Klebsiella pneumoniae isolation in urine cultures and infected wounds on a rehabilitation unit and to compare typing methods for K pneumoniae isolates.
Retrospective review of laboratory reports and patient records with case-control study. Analysis of K pneumoniae isolates using capsular serotyping, enzyme electrophoretic typing, ribotyping, and DNA typing.
48-bed rehabilitation unit in an 1,100-bed tertiary care teaching hospital in Winnipeg, Manitoba.
In 1988, 20 (19%) of 106 patients admitted to the rehabilitation unit had K pneumoniae isolated from urine or wound, and in 1989 31 (28%) of 111 patients had Klebsiella isolated. Review of ward practices revealed appropriate written policies but evidence of failure in execution leading to multiple opportunities for transmission among patients. Substantial environmental contamination was not identified, although a common urine graduate may have contributed to some transmission. Individuals with K pneumoniae isolated had a significantly longer duration of stay. Many of these were spinal cord-injured patients and were maintained on intermittent catheterization. One outbreak strain was identified in epidemiologic typing. Other strains were generally identified in individuals with non-nosocomial acquisition of infection. Comparison of epidemiologic typing methods suggests ribotyping may be the optimal method for typing K pneumoniae strains.
K pneumoniae was acquired frequently by spinal cord-injured patients with extended admissions, re-emphasizing the importance of both patients and staff following appropriate infection control practices on rehabilitation wards. Ribotyping was the optimal method for typing K pneumoniae isolates.
确定与康复病房尿培养和感染伤口中肺炎克雷伯菌分离率增加相关的因素，并比较肺炎克雷伯菌分离株的分型方法。
采用病例对照研究对实验室报告和患者记录进行回顾性分析。使用荚膜血清分型、酶电泳分型、核糖分型和DNA分型对肺炎克雷伯菌分离株进行分析。
加拿大马尼托巴省温尼伯市一家拥有1100张床位的三级护理教学医院的48张床位康复病房。
1988年，106名入住康复病房的患者中有20名（19%）尿或伤口中分离出肺炎克雷伯菌，1989年111名患者中有31名（28%）分离出克雷伯菌。对病房操作的审查发现有适当的书面政策，但有执行不力的证据，导致患者之间有多次传播机会。虽然一个普通的尿量筒可能促成了一些传播，但未发现严重的环境污染。分离出肺炎克雷伯菌的患者住院时间明显更长。其中许多是脊髓损伤患者，采用间歇性导尿。在流行病学分型中鉴定出一株暴发菌株。其他菌株通常在非医院获得性感染的个体中鉴定出。流行病学分型方法的比较表明，核糖分型可能是肺炎克雷伯菌菌株分型的最佳方法。
脊髓损伤且住院时间延长的患者经常感染肺炎克雷伯菌，再次强调了患者和工作人员在康复病房遵循适当感染控制措施的重要性。核糖分型是肺炎克雷伯菌分离株分型的最佳方法。
