Outbreak of extended spectrum beta  lactamase producing Klebsiella pneumoniae in a neonatal unit

Abstract

An outbreak of extended spectrum lactamase producing Klebsiella pneumoniae (ESBLKp) in a neonatal unit was controlled using simple measures. Normally, the control of such infections can be time consuming and expensive. Seven cases of septicaemia resulted in two deaths. ESBLKp isolates were subtyped by pulsed field gel electrophoresis, and four of the five isolates typed were identical. Control of the outbreak was achieved by altered empiric antibiotic treatment for late onset sepsis and prevention of cross infection by strict attention to hand washing. Widespread colonisation of babies in the unit was presumed, so initial surveillance cultures were not performed. No further episodes of sepsis occurred. (Arch Dis Child Fetal Neonatal Ed 1999;80:F64-F68)

Study of multi-drug resistant microorganisms isolated from blood cultures of hospitalized newborns in Rio de Janeiro city, Brazil

“…The observations reported in our study concerning invasive procedures and other conditions are in accordance with those of several authors, who described similar risk conditions for acquisition of HI and death in NICUs (3)(4)(5)8,13,17) During certain periods in the present study, the NICU was overcrowded and we cannot discount the possible breakdown in the application of aseptic techniques, especially hand washing during manipulation of newborns, which have may facilitated cross-infections. These factors have also been mentioned in reports from other hospital units (4,16,21,26,30).…”

“…This practice have may exerted selective pressures leading to the emergence of multi-drug resistant strains (8,16,26,30), which in turn may have stimulated the acquisition of genes encoding resistance mechanisms via horizontal transfer mechanisms between bacterial strains within the hospital environment (16,29). It is of particular interest, that in this study a significant number of patients (83.1%) received antimicrobial drugs before positive blood culture presentation (empiric use), due to clinical manifestations suggestive of sepsis.…”

“…The KES group is composed by pathogens of significant morbidity and mortality in immunocompromissed and debilitated patients, as well as newborns, and these bacterial species frequently transfer their resistance genes to susceptible strains during outbreaks (23,26).…”

Extended-Spectrum β-Lactamase-ProducingKlebsiellapneumoniaein a Neonatal Intensive Care Unit in the High-Prevalence Area of Athens, Greece

“…Control of epidemics due to this pathogen may benefit from detailed typing. As also demonstrated here, PFGE is effective in delineating the epidemiology of K. pneumoniae nosocomial infections (6,15). The results provided by PFGE showed that a distinct "in-house" strain (cluster A) was responsible for most colonizations and infections that occurred during hospitalization.…”

“…Irrespective of the primary source, it seems that the most significant reservoir of the microorganism is the digestive tract of colonized patients and that transmission occurs mostly via the hands of nursing staff (3,8). During the past decade, strains of K. pneumoniae exhibiting resistance to newer cephalosporins due to the production of extended-spectrum ␤-lactamases (ESBLs) have been frequently implicated in outbreaks in pediatric hospitals and neonatal intensive care units (NICUs) (1,15,16,20). These strains usually exhibit cross-resistance to other antibiotics, such as aminoglycosides.…”