{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T04:34:16Z","timestamp":1784608456117,"version":"3.55.0"},"reference-count":17,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T00:00:00Z","timestamp":1420156800000},"content-version":"unspecified","delay-in-days":3745,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control"],"published-print":{"date-parts":[[2004,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0195941700080334_abs1\"><jats:title>Objectives:<\/jats:title><jats:p>To identify risk factors for the respiratory acquisition of extended-spectrum beta-lactamase (ESBL)-producing <jats:italic>Klebsiella pneumoniae<\/jats:italic> among patients admitted to a neurosurgical intensive care unit (NSICU) and to modify them without changing general infection control measures.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700080334_abs2\"><jats:title>Design:<\/jats:title><jats:p>Nested case-control and intervention study.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700080334_abs3\"><jats:title>Setting:<\/jats:title><jats:p>A 1,200-bed, tertiary-care teaching hospital with a 17-bed NSICU.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700080334_abs4\"><jats:title>Methods:<\/jats:title><jats:p>Sputa of all patients admitted to the NSICU were cultured weekly during the study. From October 2002 through February 2003, 29 case-patients from whose sputum ESBL-producing <jats:italic>K. pneumoniae<\/jats:italic> was isolated were detected and 59 controls-patients were randomly selected among patients without any positive isolate of ESBL-producing <jats:italic>K. pneumoniae.<\/jats:italic> After analyzing the risk factors, we intervened to modify them and compared the acquisition rate of ESBL-producing <jats:italic>K. pneumoniae<\/jats:italic> before (October 2002 to February 2003) and after (April to August 2003) the intervention.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700080334_abs5\"><jats:title>Results:<\/jats:title><jats:p>Multivariate analysis showed that prior exposure to third-generation cephalosporins (TGCs) (OR, 6.0; CI<jats:sub>95<\/jats:sub>, 1.9 to 18.6; <jats:italic>P<\/jats:italic>= .002) was an independent risk factor of ESBL-producing <jats:italic>K. pneumoniae<\/jats:italic> acquisition. The neurosurgical team was notified of the result, and the infectious diseases specialist visited the NSICU three times a week to regulate TGC use during the intervention period. Patients admitted before the intervention were older than patients admitted after. The respiratory acquisition of ESBL-producing <jats:italic>K. pneumoniae<\/jats:italic> per 1,000 patient-days (13.5 [CI<jats:sub>95<\/jats:sub>, 8.9 to 18.1] vs 2.7 [CI<jats:sub>95<\/jats:sub>, 0.9 to 4.6]) and the antimicrobial use density of TGCs (38.2 \u00b1 5.0 vs 17.3 \u00b1 2.6; <jats:italic>P<\/jats:italic> &lt; .001) decreased significantly after the intervention.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700080334_abs6\"><jats:title>Conclusion:<\/jats:title><jats:p>Prior exposure to TGCs was an independent risk factor for the respiratory acquisition of ESBL-producing <jats:italic>K. pneumoniae,<\/jats:italic> and less use of TGCs was associated with a decrease in acquisition.<\/jats:p><\/jats:sec>","DOI":"10.1086\/502304","type":"journal-article","created":{"date-parts":[[2006,4,14]],"date-time":"2006-04-14T18:00:41Z","timestamp":1145037641000},"page":"832-837","source":"Crossref","is-referenced-by-count":62,"title":["Reduced Use of Third-Generation Cephalosporins Decreases the Acquisition of Extended-Spectrum Beta-Lactamase-Producing <i>Klebsiella pneumoniae<\/i>"],"prefix":"10.1017","volume":"25","author":[{"given":"Sang-Oh","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Sun","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin Young","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue-Yun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiel-Hae","family":"Seo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong Kyun","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,1,2]]},"reference":[{"key":"S0195941700080334_ref009","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.14.1233"},{"key":"S0195941700080334_ref004","doi-asserted-by":"publisher","DOI":"10.1086\/502245"},{"key":"S0195941700080334_ref017","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.70.9.793"},{"key":"S0195941700080334_ref011","doi-asserted-by":"publisher","DOI":"10.1053\/jhin.2002.1331"},{"key":"S0195941700080334_ref005","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-119-5-199309010-00001"},{"key":"S0195941700080334_ref006","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1128\/AAC.42.1.53","article-title":"Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended-spectrum 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