CEFTAZIDIME-RESISTANT KLEBSIELLA-PNEUMONIAE ISOLATES RECOVERED AT THECLEVELAND DEPARTMENT-OF-VETERANS-AFFAIRS MEDICAL-CENTER

The rate of ceftazidime resistance among Klebsiella pneumoniae isolate s recovered from patients at the Cleveland Department of Veterans Affa irs Medical Center increased from 6% in the first quarter of 1993 to 2 8% in the first quarter of 1994, The outbreak was hospitalwide, with t he highest rates of resistance occurring on wards where ceftazidime wa s administered most frequently, Although many plasmid patterns were ob served in the clinical isolates, molecular epidemiological analysis wi th use of pulsed field gel electrophoresis revealed substantial simila rities between the strains; this finding suggested that most of the st rains - if not all of them - were derived from the original clone, The addition of piperacillin/tazobactam to the hospital formulary and edu cational efforts focused on minimizing the administration of ceftazidi me were associated with a marked decrease in the drug's use and a conc omitant decrease in the percentage of ceftazidime-resistant isolates, We have not yet observed a significant rise in the rate of resistance to piperacillin/tazobactam among clinical isolates of K. pneumoniae.