Nosocomial Klebsiella Infection in a Neonatal Unit: Identification of Risk Factors for Gastrointestinal Colonization

Abstract

Sequential outbreaks of infection due to gentamicin-resistant Klebsiella pneumoniae (GRKP) types 30 and 19 occurred in the neonatal intensive care unit (NICU) at the Medical College of Virginia in 1977 and 1978. The extensive epidemiologic investigation carried out included a case-control study, careful review of aseptic technique, and cultures from nursery staff and environment. The gastrointestinal (GI) tracts of the patients were the reservoirs for GRKP, and the epidemic strain was transmitted by hands of personnel. The case-control study showed a significant relationship between acquisition of GRKP by patients and oropharyngeal and GI instrumentation, including use of bag resuscitation, oropharyngeal suctioning, and use of nasogastric feeding tubes. The findings of the case-control study were supported by observation of the patient care techniques practiced by NICU staff. Institution of control measures based on results of the epidemiologic investigation of the first outbreak rapidly brought the second outbreak under control, even though cohorting or use of routine isolation was not possible. Whereas GI colonization and hand transmission have been described previously in outbreaks of K. pneumoniae infections in NICUs, this study is the first to document the mode of inoculation of patients' GI tracts by contaminated hands of personnel.

A case-control study of risk factors associated with rectal colonization of extended-spectrum beta-lactamase producing sp. in newborn infants

“…infections in general, [12][13][14][15] we found the gastrointestinal tract to be a common and important site of colonization. Morgan et al 5 found only two of 12 infected infants did not have rectal colonization at the time of sepsis; all our infants with ESBL Klebsiella sp.…”

Molecular Epidemiology of Gram-Negative Bacilli from Infected Neonates and Health Care Workers' Hands in Neonatal Intensive Care Units

“…Gram-positive cocci, particularly streptococci and Staphylococcus aureus, were the most common cause of hospital-acquired infection in the first half of the century, followed by the emergence of gram-negative bacilli, such as K. pneumoniae and Enterobacteriaceae, in the 1970s [17][18][19]. With the development of antimicrobial agents effective against gram-negative pathogens, gram-positive organisms became the most common cause of infection with the problematic emergence of methicillin-resistant S. aureus [20] and vancomycin-resistant enterococci [21].…”

ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients

“…Cross‐transmission via HCWs’ hands seems to be important in the nosocomial spread of K. pneumoniae strains . Indeed there is extensive evidence for transmission via the hands of HCWs from colonized patients or environmental reservoirs to new patients, in both epidemic and endemic situations . However, in a recent study, an outbreak caused by contaminated food was described, indicating that transmission may also occur via the food chain .…”