1c:I[419806,["/_next/static/chunks/bb923814e1f4d2e9.js","/_next/static/chunks/dd3ee9f5b7716ca6.js","/_next/static/chunks/4204a0ae82542ca8.js","/_next/static/chunks/30036bedc5269936.js","/_next/static/chunks/6e1aa89a642f40be.js","/_next/static/chunks/cd5e572bc3e4eb92.js","/_next/static/chunks/8ffd0b71567920d8.js","/_next/static/chunks/67ea6dfd21f16c5f.js","/_next/static/chunks/24eb4379f68013fd.js","/_next/static/chunks/b8cd775ffdf935bd.js","/_next/static/chunks/983103cd9eb7b428.js","/_next/static/chunks/d4ac9dcf27f6ff52.js","/_next/static/chunks/294b9525248c8e5f.js"],"default"] 1d:T408,In the 15 months, February 1976 to April 1977, more than 241 patients became colonized with a strain of Klebsiella aerogenes, capsular serotype K2, resistant to most antibiotics. Urinary tract infection was the most common clinical manifestation but bacteraemia and, occasionally, infections of other sites were encountered. The main reservoir of the epidemic klebsiella was the gut, urine and skin of colonized patients. Gut carriage among staff was very uncommon. The most susceptible patients were elderly males, with debilitating illnesses and urinary tract abnormalities, especially if they were catheterized or receiving antibiotics. Likely vehicles for spread were the hands of staff, and contaminated bedpans and urinals. Control measures were directed at these factors. At the end of April 1977 no new cases had occurred for 3 months in the ward in which the outbreak began, and which had been the main focus of infection, and only 5 patients in the affected hospitals were known to be colonized by the epidemic klebsiella.1e:T42f,Late in 1973 at the Nashville Veterans Administration Hospital, an intrusion of Serratia marcescens infections that were resistant to gentamicin sulfate and other antimicrobial agents occurred. This abated somewhat, only to be superseded by another wave of multiply-resistant infections due to Klebsiella pneumoniae beginning in the spring of 1974. Approximately 400 patients had substantial infections with these organisms during the 2 1/4 year period, imposing considerable morbidity and mortality. Due to the serious and lasting impact that these events imposed on patient care in our hospital, we sought explanations for the sequential infectious outbreaks. Both may have arisen because of the same persisting pressures favoring prevalence of multidrug-resistant bacteria. Indirect evidence including the sequential order of the outbreaks, similarity of antibiotograms, transferable multiple drug resistance from Serratia to Klebsiella, and possession of approximately equal molecular weight plasmids supported the notion that the two outbreaks were causally related.1f:T46d,Late in 1973 at the Nashville Veterans Administration Hospital, an intrusion ofSerratia marcescensinfections that were resistant to gentamicin sulfate and other antimicrobial agents occurred. This abated somewhat, only to be superseded by anther wave of multiply-resistant infections due toKlebsiella pneumoniaebeginning in the spring of 1974. Approximately 400 patients had substantial infections with these organisms during the 2 1/4-year period, imposing considerable morbidity and mortality. Due to the serious and lasting impact that these events imposed on patient care in our hospital, we sought explanations for the sequential infectious outbreaks. Both may have arisen because of the same persisting pressures favoring prevalence of multidrug-resistant bacteria. Indirect evidence including the sequential order of the outbreaks, similarity of antibiotograms, transferable multiple drug resistance fromSerratiatoKlebsiella, and possession of approximately equal molecular weight plasmids supported the notion that the two outbreaks were causally related. (Arch Intern Med137:581-584, 1977)

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