Outbreak of extended spectrum beta lactamase producing Klebsiella pneumoniae in a neonatal unit (original) (raw)
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European Journal of Clinical Microbiology & Infectious Diseases, 2007
The extended-spectrum beta-lactamase (ESBL)producing Klebsiella spp. cause worldwide problems in intensive care units. The aim of this study was to investigate the molecular epidemiology of ESBL-producing Klebsiella pneumoniae and K. oxytoca strains in a neonatal intensive care unit (NICU) in Budapest, Hungary and to determine the risk factors of the infections and the epidemiological features. Infections with Klebsiella spp. were analyzed retrospectively by reviewing the medical records between January 2001 and December 2005. Antibiotic susceptibility tests, isoelectric focusing, pulsed field gel electrophoresis, plasmid analysis, PCR for bla TEM and bla SHV and DNA sequencing analysis were performed on ESBL-producing Klebsiella isolates. A total of 45 babies were found to be infected with non-ESBL-producing Klebsiella spp. and 39 with ESBL-producing Klebsiella spp. Of the parameters analyzed, including sex, gestational age, twin pregnancy, birth weight, presence of central vascular catheter, mechanical ventilator use, parenteral nutrition, polymicrobial infection, caesarean section, transfusion and mortality, we found no statistically significant difference between the ESBL and the non-ESBL groups, or between the K. pneumoniae and K. oxytoca species. Further characterization of the ESBLproducing K. pneumoniae and K. oxytoca strains isolated between February 2001 and January 2003 revealed three distinct PFGE patterns of SHV-5-producing K. pneumoniae (A, B, E) and two distinct patterns of SHV-12-producing K. oxytoca (C,D) isolates; these had different plasmid profiles. From July to November 2005, a new SHV-5 producing K. oxytoca (F) was isolated. The molecular epidemiology of ESBL-producing organisms in a NICU over time shows substantial shifts in predominant strains. The ESBL production of the infected organisms has an impact on the survival of newborn babies with infections caused by Klebsiella spp.
Journal of clinical microbiology, 2002
Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (EPKP) strains are frequently implicated in outbreaks in neonatal intensive care units (NICUs). During the period from 1997 to 1998, 21 infections and 23 colonizations with EPKP were recorded in the NICU of a children's hospital in Athens, Greece. Seventeen of the infected and 12 of the colonized neonates had been referred from other hospitals. The remaining infections and colonizations occurred during the current hospitalization. Pulsed-field gel electrophoresis typing showed that the latter cases were due to an outbreak strain that persisted in the unit, while the repeated introduction of EPKP carriers was mostly due to clonal outbreaks in two maternity hospitals.
Scandinavian Journal of Infectious Diseases, 2013
Background: A CTX-M-15 extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae was responsible for an outbreak in the neonatal intensive care unit (NICU) at Stavanger University Hospital, Norway over a 5-month period (November 2008 -April 2009. The risk factors for acquiring ESBL-producing K. pneumoniae during the outbreak were examined in this study. Methods: Faecal or rectal cultures were obtained from infants hospitalized in the NICU during the outbreak period and examined for ESBL-producing K. pneumoniae. Data were retrospectively retrieved from the medical records, including sex, gestational age, birth weight, indwelling central vascular catheter, continuous positive airway pressure (CPAP), mechanical ventilation, parenteral nutrition, antibiotic treatment, mode of delivery (vaginal vs caesarean), length of hospital stay, and mortality. Results: A total of 216 infants were hospitalized in the NICU during the outbreak period, of whom 212 were screened; 51 (24%) scored positive for faecal colonization with ESBL-producing K. pneumoniae. One infant acquired a clinical infection. Forty-four colonized infants and 55 non-colonized infants were included in the risk analysis. Colonized infants had a lower birth weight, lower gestational age, and a longer hospital stay compared to noncolonized infants. By logistic regression, prematurity (gestational age Ͻ 37 weeks) and treatment with antibiotics were independent risk factors for acquiring ESBL-producing K. pneumoniae in the fi nal model. Conclusion: Prematurity and treatment with antibiotics were independent risk factors for colonization during this NICU outbreak with ESBL-producing K. pneumoniae.
Infection Control and Hospital Epidemiology, 2004
Klebsiella pneumoniae is a well-described healthcareassociated pathogen and a cause of sepsis, urinary tract infections, pneumonia, and soft tissue infections in patients in the neonatal intensive care unit (NICU). 1,2 The emergence of extended-spectrum beta-lactamase (ESBL) production in K. pneumoniae was first reported in 1983, 3 but outbreaks associated with increased morbidity and mortality have been noted with increasing frequency in intensive care units (ICUs), including NICUs. 4 The most common reservoir for this pathogen appears to be the gastrointestinal tract of colonized patients, 5 and patient-to-patient transmission is facilitated by transient or persistent hand carriage of healthcare workers (HCWs). 6 Strategies to control outbreaks have included antibiotic control policies; cohorting infected and colonized patients; transmission precautions; surveillance cultures of patients, the environment, and HCWs; and improving hand hygiene. 7-10 In April 2001, routine surveillance by the Department of Epidemiology staff of the clinical microbiology laboratory reports revealed an increase in ESBL-producing K. pneumoniae infections in our level III-IV, 45-bed NICU. The infection control strategies implemented to contain this outbreak and a case-control study conducted to determine possible risk factors for acquisition of ESBL-producing K. pneumoniae in this NICU population are described. METHODS Identification of the Outbreak In April 2001, routine surveillance of computerized microbiology laboratory reports by the Department of Epidemiology indicated an increase in the number of infections caused by ESBL-producing K. pneumoniae in the level III-IV NICU of a university-affiliated children's hospital in New York City. An incident case was defined as an infant infected or colonized with ESBL-producing K. pneumoniae, and included cases identified by surveillance cultures. Incidence was expressed as the number of infected infants per 1,000 patient-days. Approval was obtained from the institutional review board to report on this outbreak.
Journal of Hospital Infection, 2001
This study describes the clinical outcome of an outbreak of extended-spectrum -lactamase producing Klebsiella pneumoniae (ESBL-KP) bacteraemia. Ninety-two episodes of hospital-acquired K. pneumoniae bacteraemia were studied, 49 ESBL-KP and 43 non-ESBL-KP, from May 1993 to June 1995. Of these, 44 (90%) episodes of ESBL-KP vs. 20 (46%) episodes of non-ESBL-KP occurred in intensive care unit (ICU) patients. The incidence of K. pneumoniae bacteraemia (mainly due to ESBL-KP) increased in the ICU during the outbreak. A significant association was found between intravascular catheter-related bacteraemia and isolation of ESBL-KP [27 (56%) in the ESBL-KP group vs. 13 (30%) in the non-ESBL-KP group; P:0.01]. The worst prognostic features were identified as age 965 years (P:0.02), septic shock (P:0.001) and secondary bacteraemia (P:0.04). High rates of resistance to -lactam/-lactamase inhibitors observed in our ESBL-KP isolates, as well as variable activity of aminoglycosides, restricts the empirical use of these antibiotics. Carbapenems should be the treatment of choice since they are uniformly active against these strains. Our study shows that ESBL-KP bacteraemia occurring in an epidemic ICU setting is mainly catheter-related. We did not find ESBL strains to be associated with a significantly poor outcome.
American Journal of Infection Control, 2014
Background: Extended-spectrum b-lactamase (ESBL)-producing Klebsiella species cause worldwide problems in neonatal intensive care units (NICUs). This study aimed to determine possible risk factors for infection or colonization with ESBL-producing Klebsiella pneumoniae (ESBLKp) during an outbreak in the NICU. Methods: A retrospective cohort study was conducted among neonates admitted to the NICU of a teaching hospital in Riyadh, Saudi Arabia, during an outbreak of ESBLKp from April to July 2008. The incidence density ratio was calculated to determine possible predictors of ESBLKp colonization or infection. Results: During 2,265 person-days of follow-up of 118 neonates, 4 became infected, and 8 were colonized with ESBLKp. Univariate analyzes revealed that, among 14 neonates who were treated with vancomycin, 9 (64.3%) developed infection or colonization with ESBLKp, whereas, among 104 neonates who were not treated with vancomycin, 3 (2.9%) were affected, with an incidence density ratio of 4.22 (95% confidence interval: 1.47-5.15). Parenteral feeding and mechanical ventilation were found to be marginally significant risk factors. Conclusion: Treatment with vancomycin appears to be a risk factor for infection or colonization with ESBLKp in the NICU setting.