Eradication of an extensive outbreak in a neonatal unit caused by two sequential Klebsiella pneumoniae clones harbouring related plasmids encoding an extended-spectrum β-lactamase

Velasco, C.; Rodríguez-Baño, Jesús; García, Lola; Díaz, P.; Lupión, Carmen; Durán, Laura Buzón; Pascual, Álvaro

doi:10.1016/j.jhin.2009.06.013

Cited by 26 publications

(16 citation statements)

References 35 publications

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“…Therefore, both infection control measures and applying new empirical antibiotic policies, especially decreased usage of broad-spectrum cephalosporin, may help to reduce the incidence of MDR GNB colonization and outbreak. 35,36 Our results suggested that initial antimicrobial regimen could be based on previous antibiotic use, and local surveillance data and local NICU antibiograms are recommended for the optimization of initial antibiotic choice. 37,38 There were some limitations to this study.…”

Section: Discussionmentioning

confidence: 84%

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT:There is a perception that Gram-negative bacilli (GNB) bloodstream infection is increasing in the NICU, and those infections caused by a multidrug-resistant (MDR) strain are a growing threat to hospitalized patients. WHAT THIS STUDY ADDS:Exposure to broad-spectrum antibiotics is the most important risk factor for MDR GNB bacteremia, which is associated with higher mortality. Neonates with risk factors for bacteremia caused by a MDR GNB strain may benefit from empirical antimicrobial therapy with carbapenem. abstract OBJECTIVES: To assess the risk factors antibiotic therapy and outcomes of multidrug-resistant (MDR) Gram-negative bacilli (GNB) bacteremia in NICU patients. METHODS:Episodes of MDR GNB bacteremia were compared with a non-MDR GNB bacteremia group in an 8-year cohort study. RESULTS:Of 1106 bacteremias, 393 (35.5%) were caused by GNB. Seventy (18.6%) were caused by an MDR strain. The most frequent mechanism of resistance was extended-spectrum b-lactamase production (67.1%), mainly by Klebsiella pneumoniae (59.6%). Previous antibiotic exposure to third-generation cephalosporin (odds ratio [OR]: 5.97; 95% confidence interval [CI]: 2.37-15.08; P , .001) and carbapenem (OR: 3.60; 95% CI: 1.26-10.29; P = .017) and underlying renal disease (OR: 7.08; 95% CI: 1.74-28.83; P = .006) were identified as independent risk factors for MDR GNB acquisition. Patients with MDR GNB bacteremia more likely received inadequate initial antibiotic therapy (72.9% vs 7.8%; P , .001) had higher rates of infectious complication (21.4% vs 10.5%; P = .011) and overall case fatality 1rate (28.6% vs 10.5%; P , .001). Independent risk factors for overall mortality were presence of infectious complications after bacteremia (OR: 3.16; 95% CI: 1.41-7.08; P = .005) and underlying secondary pulmonary hypertension with or without cor pulmonale (OR: 6.19; 95% CI: 1.88-20.31; P = .003).CONCLUSIONS: MDR GNB accounted for 18.6% of all neonatal GNB bacteremia in the NICU, especially in those with previous broad-spectrum antibiotic therapy and underlying renal disease. The most frequent mechanism of resistance was extended-spectrum b-lactamase (ESBL) production. Neonates with MDR GNB were more likely to develop infectious complications, which were independently associated with a higher overall case-fatality rate. Pediatrics 2014;133:e322-e329

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Section: Discussionmentioning

confidence: 84%

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

et al. 2014

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“…Although many outbreaks have been resolved rapidly by reimplementation of hygiene control measures, there have been some instances where the outbreak was only resolved by temporary ward closure (26,33,35).…”

Section: Discussionmentioning

confidence: 99%

“…Ciprofloxacin was added to imipenem because of its excellent brain tissue penetration to prevent the abscess complications frequently observed in neonatal meningitis due to Gram-negative bacilli (24). While K. pneumoniae was the ESBL-producing species most frequently involved in nosocomial outbreaks (1,23,35), this has changed since the 1990s. In France, from 1998 to 2005, the prevalence of ESBL-producing K. pneumoniae isolates decreased from 9.4% to 3.7%, whereas that of ESBL-producing E. coli isolates increased from 0.2% to 1.99% (17).…”

Section: Discussionmentioning

confidence: 99%

“…In 2008, Boyer-Mariotte et al reported one case of fatal neonatal meningitis caused by a CTX-M-15-producing E. coli strain (7). Emergence of ESBL-producing Enterobacteriaceae is a major problem, since the choice of drugs for antimicrobial treatment is limited; moreover, such strains have been increasingly implicated in nosocomial outbreaks in neonatal intensive care units (11,23,33,35). While the spread of CTX-M-type ESBL in the family Enterobacteriaceae, especially in E. coli, has been described worldwide (11,13,15,17), the spread of TEM-type ESBL has been less frequently reported (8,9).…”

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confidence: 99%

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Meningitis Caused by Escherichia coli Producing TEM-52 Extended-Spectrum β-Lactamase within an Extensive Outbreak in a Neonatal Ward: Epidemiological Investigation and Characterization of the Strain

et al. 2010

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Outbreaks caused by Enterobacteriaceae isolates producing extended-spectrum ␤-lactamases (ESBL) in neonatal wards can be difficult to control. We report here an extensive outbreak in a neonatal ward with a case of meningitis caused by an ESBL-producing Escherichia coli strain. Between 24 March and 29 April 2009, among the 59 neonates present in the ward, 26 neonates with ESBL-producing E. coli rectal colonization were detected (44%). One of the colonized neonates developed meningitis with a favorable outcome after treatment combining imipenem, gentamicin, and ciprofloxacin. Despite strict intensification of hygiene and isolation procedures for more than 1 month, ward closure to new admissions was necessary to control the outbreak. Randomly amplified polymorphic DNA and pulsed-field gel electrophoresis analysis performed on 31 isolates recovered from 26 neonates and two mother's milk samples showed a clonal strain. ESBL PCR assays indicated that the strain harbored a TEM-52 ESBL encoded by an IncI1 replicon. Phylogenetic analysis by multilocus sequence typing showed that the strain belonged to rare phylogenetic group C, which is closely related to group B1 but appears as group A by the triplex PCR phylogrouping method. The strain harbored the virulence genes fuyA, aer, and iroN and was virulent in a mouse model of septicemia. This work indicates the high potential of colonization, transmission, and virulence of some ESBL-producing E. coli clones.With Streptococcus agalactiae, Escherichia coli is one of the two most common bacterial species frequently responsible of neonatal infections (34). E. coli is the second leading cause of neonatal bacterial meningitis in industrial countries, and recent studies suggest that extraintestinal pathogenic E. coli isolates belong mainly to phylogenetic group B2 (2, 6). An increased rate of E. coli ampicillin resistance after the initiation of intrapartum antimicrobial prophylaxis was previously reported (5, 34). However, most of the E. coli isolates remained susceptible to extended-spectrum cephalosporins (ESC), but currently, extended-spectrum ␤-lactamases (ESBL) are becoming an increasingly important cause of resistance to ESC in E. coli, frequently involving the CTX-M-type enzymes (29). In 2008, Boyer-Mariotte et al. reported one case of fatal neonatal meningitis caused by a CTX-M-15-producing E. coli strain (7). Emergence of ESBL-producing Enterobacteriaceae is a major problem, since the choice of drugs for antimicrobial treatment is limited; moreover, such strains have been increasingly implicated in nosocomial outbreaks in neonatal intensive care units (11,23,33,35). While the spread of CTX-M-type ESBL in the family Enterobacteriaceae, especially in E. coli, has been described worldwide (11,13,15,17), the spread of TEM-type ESBL has been less frequently reported (8, 9). We report here a case of neonatal meningitis caused by a TEM-52 ESBL-producing E. coli strain within a serious outbreak among neonates with rectal colonization and the characteristics of the strain. MATERIA...

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“…Im Rahmen der Intervention bei Ausbrüchen von ESBL-bildenden Klebsiellen wurden Surveillance-Kulturen, Isolierung und Kohortierung der Patienten, zum Teil in gesonderten Bereichen, und Kohortierung des Pflegepersonals eingesetzt [171,356].…”

Section: Klebsiella Sppunclassified

Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen

2012

Bundesgesundheitsbl.

281

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Eradication of an extensive outbreak in a neonatal unit caused by two sequential Klebsiella pneumoniae clones harbouring related plasmids encoding an extended-spectrum β-lactamase

Cited by 26 publications

References 35 publications

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

Meningitis Caused by Escherichia coli Producing TEM-52 Extended-Spectrum β-Lactamase within an Extensive Outbreak in a Neonatal Ward: Epidemiological Investigation and Characterization of the Strain

Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen

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