Klebsiella pneumoniae with extended spectrum beta-lactamase activity associated with a necrotizing enterocolitis outbreak

Gregersen, Nerine; Nierop, W van; Gottberg, Anne von; Duse, Adrian; Davies, Vic; Cooper, Peter

doi:10.1097/00006454-199911000-00005

Cited by 35 publications

(24 citation statements)

References 13 publications

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“…Many studies on outbreaks of NEC reported either very low rates of NEC11–13, 17, 19, 22, 31 or did not report a background rate,10, 14, 15, 18, 29, 32 leading the reader to assume that perhaps that particular site typically sees a minimal number of NEC cases within their institution. Our NICUs have a relatively endemic rate of NEC.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Necrotizing Enterocolitis Temporal Clustering in Two Neonatology Practices

Meinzen‐Derr

Morrow

Hornung

et al. 2009

The Journal of Pediatrics

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Objective-To develop a statistical method for defining clusters of necrotizing enterocolitis (NEC) cases in the neonatal intensive care unit (NICU).Study design-2782 infants, between 1996-2004, weighing 401-1500 grams at birth were included. NEC was defined as Bell stage II or III. Two statistical methods used to define "disease clusters" were: (1) modified scan test; (2) comparison of observed and expected incidence density rates (IDR) of NEC at each NICU.Results-The proportion of infants with NEC was similar between NICUs (7.1% vs. 7.7%; p=0.6) as was the expected IDR of NEC (1.39/1000 patient-days vs. 1.32/1000 patient-days, p=0.72). Twelve temporal clusters of NEC were identified in the NICUs combined, comprising 18% of 203 total NEC cases during the study period. No seasonal/secular trends were noted for NEC rates or identified clusters. Potential NEC clusters of ≥3 cases at either NICU had >75% chance of being a true NEC cluster.Conclusions-No operational definition of NEC cluster exists. This study introduced methods to be employed for prospective surveillance and guide studies to investigate etiologic relevance. Utilizing the proposed methods, statistically significant clusters (potential outbreaks) of NEC within NICUs can be identified early, providing early opportunity to implement cluster investigation protocols. Keywords disease clusters; outbreaks; neonatal intensive care unit; very low birth weight infantsCorresponding Author: Jareen Meinzen-Derr, Ph.D., 3333 Burnet Ave, MLC 5041, Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, Email: E-mail: jareen.meinzen-derr@cchmc.org. Edited by Padbury and WFBThe authors declare no conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Necrotizing enterocolitis (NEC), the most common gastrointestinal emergency in the neonatal intensive care unit (NICU), is a sudden-onset life-threatening disease that occurs primarily in preterm infants. NEC affects approximately 6-10% of very low birthweight (VLBW) infants, 1-4 with nearly 90% of all NEC cases occurring among this population and a case-fatality rate as high as 20-40%. 5 The etiology of NEC is not clearly established, but appears to be multifactorial, involving enteral feeding, vascular or perfusion-related gastrointestinal compromise, and bacterial invasion. 6, 7 Cases appear to occur sporadically with reports of clusters or outbreaks. 8, 9 No formal or consistent approach has been applied to these reports, however, regarding the definition and timing of apparent outbreaks or the...

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Section: Discussionmentioning

confidence: 99%

Epidemiology of Necrotizing Enterocolitis Temporal Clustering in Two Neonatology Practices

Meinzen‐Derr

Morrow

Hornung

et al. 2009

The Journal of Pediatrics

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“…Klebsiella species is the most frequent aerobic species implicated in NEC, but most microbiologic analyses of NEC cases involving Klebsiella did not include anaerobic microflora cultures (17,18). Westra-Meijer et al (19), comparing aerobic and anaerobic fecal flora in healthy preterm infants and infants with NEC, observed a higher colonization with Klebsiella species in infants with NEC but no difference in clostridia populations.…”

Section: Discussionmentioning

confidence: 99%

Evidence for Clostridial Implication in Necrotizing Enterocolitis through Bacterial Fermentation in a Gnotobiotic Quail Model

et al. 2005

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“…55,56 Klebsiella pneumoniae: Extended-spectrum b-lactamaseproducing strains of K. pneumoniae have been reported to cause hospital outbreaks of sepsis associated with a high incidence of NEC. 57,58 Acinetobacter: There has been a cluster of sepsis cases related to Acinetobacter. In five patients, the condition was also associated with NEC.…”

Section: Viral Agentsmentioning

confidence: 99%

The role of the intestinal microbiota in the pathogenesis of necrotizing enterocolitis

Grishin

Papillon

Bell

et al. 2013

Seminars in Pediatric Surgery

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Development of necrotizing enterocolitis (NEC) requires a susceptible host, typically a premature infant or an infant with congenital heart disease, enteral feedings and bacterial colonization. Although there is little doubt that microbes are critically involved in the pathogenesis of NEC, the identity of specific causative pathogens remains elusive. Unlike established normal adult gut microbiota, which is quite complex, uniform, and stable, early postnatal bacterial populations are simple, diverse, and fluid. These properties complicate studies aimed at elucidating characteristics of the gut microbiome that may play a role in the pathogenesis of NEC. A broad variety of bacterial, viral, and fungal species have been implicated in both clinical and experimental NEC. Frequently, however, the same species have also been found in physiologically matched healthy individuals. Clustered outbreaks of NEC, in which the same strain of a suspected pathogen is detected in several patients suggest, but do not prove, a causative relationship between the specific pathogen and the disease. Studies in Cronobacter sakazakii, the best characterized NEC pathogen, have demonstrated that virulence is not a property of a bacterial species as a whole, but rather a characteristic of certain strains, which may explain why the same species can be pathogenic or non-pathogenic. The fact that a given microbe may be innocuous in a full-term, yet pathogenic in a pre-term infant has led to the idea of opportunistic pathogens in NEC. Progress in understanding the infectious nature of NEC may require identifying specific pathogenic strains and unambiguously establishing their virulence in animal models.

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Klebsiella pneumoniae with extended spectrum beta-lactamase activity associated with a necrotizing enterocolitis outbreak

Abstract: The isolation of a single clone of K. pneumoniae with extended spectrum of beta-lactamase activity during an NEC outbreak highlights the need for strict infection control. This organism caused significant morbidity and was difficult to treat.

Cited by 35 publications

References 13 publications

Epidemiology of Necrotizing Enterocolitis Temporal Clustering in Two Neonatology Practices

Epidemiology of Necrotizing Enterocolitis Temporal Clustering in Two Neonatology Practices

Evidence for Clostridial Implication in Necrotizing Enterocolitis through Bacterial Fermentation in a Gnotobiotic Quail Model

The role of the intestinal microbiota in the pathogenesis of necrotizing enterocolitis

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