Ann Lab Med.  2020 Mar;40(2):164-168. 10.3343/alm.2020.40.2.164.

Prevalence and Risk Factors for Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae Colonization in Intensive Care Units

  • 1Department of Laboratory Medicine, National Health Insurance Service, Ilsan Hospital, Goyang, Korea.
  • 2Department of Internal Medicine, National Health Insurance Service, Ilsan Hospital, Goyang, Korea.
  • 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 4Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.
  • 5Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.


Active surveillance culture (ASC) can help detect hidden reservoirs, but the routine use of ASC for extended spectrum β-lactamase-producing Enterobacteriaceae is controversial in an endemic situation. We aimed to determine the prevalence and risk factors of extended spectrum β-lactamase-producing Klebsiella pneumoniae (EBSL-Kpn) colonization among intensive care unit (ICU)-admitted patients. Prospective screening of ESBL-Kpn colonization was performed for ICU-admitted patients within 48 hours for two months. A perirectal swab sample was inoculated on MacConkey agar supplemented with 2 µg/mL ceftazidime. ESBL genotype was determined by PCR-sequencing, and clonal relatedness was evaluated by pulsed-field gel electrophoresis (PFGE). The risk factors of ESBL-Kpn colonization were evaluated. The ESBL-Kpn colonization rate among the 281 patients at ICU admission was 6.4% (18/281), and bla(CTX-M-15) was detected in all isolates. ESBL producers also showed resistance to fluoroquinolone (38.9%, 7/18). All isolates had the same ESBL genotype (bla(CTX-M-15)) and a highly clustered PFGE pattern, suggesting cross-transmission without a documented outbreak. In univariate analysis, the risk factor for ESBL-Kpn colonization over the control was the length of hospital stay (odds ratio=1.062; P=0.019). Routine use of ASC could help control endemic ESBL-Kpn for ICU patients.


Colonization; Extended spectrum β-lactamase; Klebsiella pneumoniae; Prevalence; Risk factor

MeSH Terms

Critical Care*
Electrophoresis, Gel, Pulsed-Field
Intensive Care Units*
Klebsiella pneumoniae*
Length of Stay
Mass Screening
Prospective Studies
Risk Factors*


  • Fig. 1 Dendrogram of XbaI-restricted DNA of colonizing ESBL-producing Klebsiella pneumoniae isolated from ICU-admitted patients (N=14). Four ESBL-producing K. pneumoniae isolates were excluded because of repeated failure of reculture. Pulsed-field gel electrophoresis was performed with size marker, Lambda Ladders (Promega, Fitchburg, WI, USA).Abbreviations: ESBL, extended-spectrum beta-lactamase; ICU, intensive care unit.


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