{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:25:38Z","timestamp":1777922738289,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2015,12,1]],"date-time":"2015-12-01T00:00:00Z","timestamp":1448928000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2015,12]]},"abstract":"<jats:p>\n                    <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                    is an important pathogen, increasingly notorious for its ability to become resistant to antimicrobial agents. This study sought to characterize trends in antimicrobial susceptibility rates for\n                    <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                    causing bacteremias across the United States (U.S.) Veterans Healthcare Administration (VHA) from 2007 through 2013 utilizing a national clinical database.\n                    <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                    grew in 9,235 blood cultures from 8,414 patients. Nationally, ampicillin\u2013sulbactam, ceftazidime, cefepime, ertapenem, fluoroquinolones, and amikacin demonstrated statistically significant susceptibility rate increases against\n                    <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                    in the 2010\u20132013 period versus the 2007\u20132009 period. No antimicrobial agent had a statistically significant nationwide susceptibility rate decrease. Of the 126 antibiotic\u2013organism pairs tested among 9 U.S. regions, 18 demonstrated statistically significant susceptibility rate increases while 6 demonstrated statistically significant susceptibility rate decreases. The East North Central (eight agents), Mid-Atlantic (five agents), and South Atlantic (four agents) regions demonstrated statistically significant susceptibility rate increases for multiple antimicrobial agents. Of the 70 antibiotic\u2013organism pairs tested among 5 different medical center complexity levels, 11 antibiotics demonstrated statistically significant susceptibility rate increases and 1 demonstrated a statistically significant rate decrease. Extended-spectrum \u03b2-lactamase production did not significantly change over the study period across an available nationwide representation of 31 facilities (10.6% in 2007\u20132009 vs. 9.21% in 2010\u20132013,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    =0.17). The South Atlantic and Mid-Atlantic regions had the highest prevalence of extended-spectrum \u00df-lactamase production in the two periods, respectively. The recent trend of generally increasing susceptibility rates for\n                    <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                    bloodstream isolates in this nationwide U.S. VHA study contrasts from other U.S. health system reports demonstrating increasing trends of antimicrobial resistance.\n                  <\/jats:p>","DOI":"10.1089\/mdr.2014.0287","type":"journal-article","created":{"date-parts":[[2015,7,24]],"date-time":"2015-07-24T15:14:20Z","timestamp":1437750860000},"page":"590-599","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Trends in Susceptibility Rates and Extended-Spectrum \u03b2-Lactamase Production of\n                    <i>Klebsiella pneumoniae<\/i>\n                    in Bloodstream Infections Across the United States Veterans Affairs Healthcare System"],"prefix":"10.1177","volume":"21","author":[{"given":"Chris A.","family":"Gentry","sequence":"first","affiliation":[{"name":"Oklahoma City VA Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"II","given":"Riley J.","family":"Williams","sequence":"additional","affiliation":[{"name":"Mercy Health System"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2015,12]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0091713"},{"issue":"1","key":"e_1_3_3_3_2","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1111\/j.1469-0691.2007.01848.x","article-title":"Extended-spectrum b-lactamases in North America, 1987\u20132006","volume":"14","author":"Bush K.","year":"2008","unstructured":"Bush K. 2008. Extended-spectrum b-lactamases in North America, 1987\u20132006. Clin. Microbiol. Infect., 14 (Suppl 1):134\u2013143.","journal-title":"Clin. Microbiol. Infect."},{"key":"e_1_3_3_4_2","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1128\/AAC.01896-13","article-title":"Contemporary diversity of \u03b2-lactamases among Enterobacteriaceae in the nine U.S. census regions and ceftazidime-avibactam activity tested against isolates producing the most prevalent \u03b2-lactamase groups","volume":"58","author":"Castanheira M.","year":"2014","unstructured":"Castanheira M., , Farrell S.E., , Krause K.M., , Jones R.N., , and Sadera H.S.. 2014. Contemporary diversity of \u03b2-lactamases among Enterobacteriaceae in the nine U.S. census regions and ceftazidime-avibactam activity tested against isolates producing the most prevalent \u03b2-lactamase groups. Antimicrob. Agents Chemother., 58:833\u2013838.","journal-title":"Antimicrob. Agents Chemother."},{"key":"e_1_3_3_5_2","unstructured":"Clinical and Laboratory Standards Institute. 2011. Performance standards for antimicrobial susceptibility testing; twenty-first informational supplement. 31:48\u201349."},{"key":"e_1_3_3_6_2","doi-asserted-by":"crossref","first-page":"2298","DOI":"10.1093\/jac\/dkr290","article-title":"Longitudinal survey of carbapenem resistance and resistance mechanisms in enterobacteriaceae and non-fermenters from the USA in 2007\u20132009","volume":"66","author":"Davies T.A.","year":"2011","unstructured":"Davies T.A., , Queenan A.M., , Morrow B.J., , Shang W., , Amsler K., , He W., et al. 2011. Longitudinal survey of carbapenem resistance and resistance mechanisms in enterobacteriaceae and non-fermenters from the USA in 2007\u20132009. J. Antimicrob. Chemother., 66:2298\u20132307.","journal-title":"J. Antimicrob. Chemother."},{"key":"e_1_3_3_7_2","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1476-0711-12-24","article-title":"Antimicrobial susceptibility among gram-negative isolates collected in the USA between 2005 and 2011 as part of the Tigecycline Evaluation and Surveillance Trial (T.E.S.T)","volume":"12","author":"Denys G.A.","year":"2013","unstructured":"Denys G.A., , Callister S.M., , and Dowzicky M.J.. 2013. Antimicrobial susceptibility among gram-negative isolates collected in the USA between 2005 and 2011 as part of the Tigecycline Evaluation and Surveillance Trial (T.E.S.T). Ann. Clin. Microbiol. Antimicrob., 12:24.","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"e_1_3_3_8_2","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1086\/671724","article-title":"Incidence trends in pathogen-specific central line-associated bloodstream infections in US intensive care units, 1990\u20132010","volume":"34","author":"Fagan R.P.","year":"2013","unstructured":"Fagan R.P., , Edwards J.R., , Park B.J., , Fridkin S.K., , and Magill S.S.. 2013. Incidence trends in pathogen-specific central line-associated bloodstream infections in US intensive care units, 1990\u20132010. Infect. Control Hosp. Epidemiol., 34:893\u2013899.","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"e_1_3_3_9_2","article-title":"Increased antimicrobial susceptibility rates for Pseudomonas aeruginosa bloodstream isolates across the veterans affairs healthcare system","author":"Gentry C.A.","unstructured":"Gentry C.A., , and Williams R.J.. Increased antimicrobial susceptibility rates for Pseudomonas aeruginosa bloodstream isolates across the veterans affairs healthcare system. Diagn. Microbiol. Infect. Dis. (in press).","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1007474"},{"key":"e_1_3_3_11_2","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1086\/652152","article-title":"Multidrug resistance among gram-negative pathogens that caused healthcare-associated infections reported to the National Healthcare Safety Network, 2006\u20132008","volume":"31","author":"Kallen A.J.","year":"2010","unstructured":"Kallen A.J., , Hidron A.I., , Patel J., , and Srinivasan A. 2010. Multidrug resistance among gram-negative pathogens that caused healthcare-associated infections reported to the National Healthcare Safety Network, 2006\u20132008. Infect. Control Hosp. Epidemiol., 31:528\u2013531.","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2009.03.034"},{"key":"e_1_3_3_13_2","unstructured":"Memorandum. Acting Assistant Deputy Under Secretary for Health for Operations and Management for Clinical Operations (10NC). 2012. Implementation of Guideline for Prevention of Clostridium difficile Infection (CDI) in Veterans Health Administration (VHA) Acute-Care Facilities (VAIQ # 7210267). Washington D.C. March 29 2012."},{"key":"e_1_3_3_14_2","doi-asserted-by":"crossref","first-page":"e60","DOI":"10.1016\/j.ijid.2011.09.021","article-title":"Activity of tigecycline and comparators against skin and skin structure pathogens: global results of the tigecycline evaluation and surveillance trial, 2004\u20132009","volume":"16","author":"Namdari H.","year":"2012","unstructured":"Namdari H., , Tan T.Y., , and Dowzicky M.J.. 2012. Activity of tigecycline and comparators against skin and skin structure pathogens: global results of the tigecycline evaluation and surveillance trial, 2004\u20132009. Int. J. Infect. Dis., 16:e60\u2013e66.","journal-title":"Int. J. Infect. Dis."},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2009.08.020"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid1901.120310"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1086\/668770"},{"key":"e_1_3_3_18_2","unstructured":"Szabo C.R. 2005 Facility Complexity Model. Washington DC: Veterans Healthcare Administration National Leadership Board Human Resources Committee. August 9 2005."},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.05035-11"},{"key":"e_1_3_3_20_2","unstructured":"VHA Directive 1031. Antimicrobial Stewardship Programs (ASP). Veterans Healthcare Administration. Available at http:\/\/vaww1.va.gov\/vhapublications\/ViewPublication.asp?.pub_ID=2964 accessed October10 2014. Published January 22 2014."},{"key":"e_1_3_3_21_2","unstructured":"VHA Directive. 2007\u2013002 Methicillin Resistant Staphylococcus Aureus (MRSA) Initiative. Veterans Healthcare Administration. Available at http:\/\/www.neverevents.org\/infections\/downloads\/VHA-MRSA-Directive-2007\u2013002.pdf accessed October10 2014. Published January 12 2007."},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1086\/421946"},{"key":"e_1_3_3_23_2","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1086\/671740","article-title":"Secular trends in gram-negative resistance among urinary tract infection hospitalizations in the United States, 2000\u20132009","volume":"34","author":"Zilberberg M.D.","year":"2013","unstructured":"Zilberberg M.D., , and Shorr A.F.. 2013. 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