Outbreak of Nosocomial Sepsis and Pneumonia in a Newborn Intensive Care Unit by Multiresistant Extended-Spectrum β-Lactamase-Producing<i>Klebsiella pneumoniae</i>High Impact on Mortality

Martínez‐Aguilar, Gerardo; Alpuche-Aranda, Celia; Anaya, Carmen; Alcántar-Curiel, Dolores; Gayosso, Catalina; Daza, Carlos; Mijares, Cesar; Tinoco, Juan Carlos; Santos, José Ignacio

doi:10.1017/s019594170007274x

Cited by 9 publications

(2 citation statements)

References 9 publications

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“…Contrary to this, a study from Mexico showed a significantly lower proportion of trained nurses caring for critically ill patients during epidemic periods of ESBL-producing K. pneumoniae. 14 In our unit, as mentioned, there were more category 4-5 patients before and during outbreaks.…”

Section: Discussionmentioning

confidence: 56%

A cross‐sectional study of neonatal intensive care unit overcrowding and understaffing associated with bacterial outbreaks

Dahl

Solevåg

2022

Acta Paediatrica

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Aim To study whether overcrowding and/or nurse understaffing preceded four bacterial outbreaks during a 5‐year period in a Norwegian university hospital neonatal intensive care unit (NICU). Methods A repeated cross‐sectional study based on prospectively collected data from the Norwegian neonatal network's (NNN) web‐based electronic database, digital work schedules and information about the outbreaks from logs, reports and publications. Number of admitted patients, category 4–5 patients (i.e., with the highest nurse to patient ratio), rostered nursing staff and nurse specialists were analysed in relation to periods (1) >28 days before individual outbreaks, (2) ≤28 days before, (3) during and (4) after outbreaks. Overcrowding and understaffing were compared between the four periods with Chi‐square test and post hoc analysis with Bonferroni correction. Results When all outbreaks were analysed together, overcrowding was more frequent in the periods within 28 days of outbreaks compared to the other periods (p < 0.001). For understaffing, the periods within 28 days of outbreaks were only different from the periods >28 days before outbreaks (p < 0.001). The trends regarding individual outbreaks were less consistent, but there were more category 4–5 patients before and during the outbreaks. Conclusion Bacterial outbreaks in a 5‐year period were weakly associated with overcrowding and understaffing.

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Section: Discussionmentioning

confidence: 56%

A cross‐sectional study of neonatal intensive care unit overcrowding and understaffing associated with bacterial outbreaks

Dahl

Solevåg

2022

Acta Paediatrica

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“…K. pneumoniae can cause severe morbidity and mortality especially among the newborn (Bingen, 1993;Casolari et al, 2005;Coovadia et al, 1992). In recent years, K. pneumoniae have frequently been reported as the cause of outbreaks involving newborn infants in neonatal intensive care units (Fangyou et al, 2009;Randrianirina et al, 2009;Jerassy et al, 2006;Casolari et al, 2005;Wachino, Doi, & Yamane, 2004;Gastmeier, Groneberg, & Weist, 2003;Lebessi et al, 2002;Martinez-Aguilar et al, 2001;Macrae et al, 2001;Roilides et al, 2000;van der Zwet et al, 1999;Al-Rabea et al, 1998;Villari, Iacuzio, Torre, & Scarcella, 1998;Banerjee et al, 1993;Reish, Ashkenazi, Naor, Samra, & Merlob, 1993;Arredondo-Garcia, Diaz-Ramos, Solorzano-Santos, Sosa-Gonzalez, & Beltran-Zuniga, 1992;Denny, St.-John, Lewis, & Daniel, 1986;Donowitz, Marsik, Fisher, & Wenzel, 1981;Hill, Hunt, & Matsen, 1974;Mayhall et al, 1980;Saravolatz, Arking, Pohlod, Fisher, & Borer, 1984;Sveningsen, Bekassy, Christensen, & Kamme, 1984). K. pneumoniae have also been found in powdered infant formula (Carneiro, Silva, Merquior, & Queiroz, 2003;Muytjens, RoelofsWillemse, & Jaspar, 1988).…”

Section: Introductionmentioning

confidence: 99%

Development of real-time PCR systems based on SYBR Green for the specific detection and quantification of Klebsiella pneumoniae in infant formula

Sun

Qiu³

et al. 2010

Food Control

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Outbreak of Yersiniabactin-producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit

Wisgrill

Lepuschitz

Blaschitz

et al. 2019

Pediatric Infectious Disease Journal

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Background: The Gram-negative bacterium Klebsiella pneumoniae is a frequent pathogen causing outbreaks in neonatal intensive care units. Some Enterobacteriaceae can acquire the ability to sequester iron from infected tissue by secretion of iron-chelating compounds such as yersiniabactin. Here we describe an outbreak and clinical management of infections because of a highly virulent yersiniabactin-producing, nonmultiresistant K. pneumoniae strain in a neonatal intensive care unit. Outbreak investigation and effectiveness assessment of multidisciplinary infection control measurements to prevent patient-to-patient transmission of highly pathogenic K. pneumoniae were undertaken. Methods: Outbreak cases were identified by isolation of K. pneumoniae from blood or stool of infants. Clinical data were abstracted from medical charts. K. pneumoniae isolates were genotyped using whole genome sequencing, and yersiniabactin production was evaluated by luciferase assay. Results: Fourteen cases were confirmed with 8 symptomatic and 6 colonized patients. Symptomatic patients were infants of extremely low gestational and chronologic age with fulminant clinical courses including necrotizing enterocolitis and sepsis. Whole genome sequencing for bacterial isolates confirmed the presence of an outbreak. All outbreak isolates produced yersiniabactin. Conclusions: Yersiniabactin-producing K. pneumoniae can display a high pathogenicity in extremely premature infants with low chronologic age. This outbreak also underlines the considerable potential of today's infection control systems for recognizing and controlling nosocomial infections in highly vulnerable populations.

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Outbreak of Nosocomial Sepsis and Pneumonia in a Newborn Intensive Care Unit by Multiresistant Extended-Spectrum β-Lactamase-ProducingKlebsiella pneumoniaeHigh Impact on Mortality

Cited by 9 publications

References 9 publications

A cross‐sectional study of neonatal intensive care unit overcrowding and understaffing associated with bacterial outbreaks

A cross‐sectional study of neonatal intensive care unit overcrowding and understaffing associated with bacterial outbreaks

Development of real-time PCR systems based on SYBR Green for the specific detection and quantification of Klebsiella pneumoniae in infant formula

Outbreak of Yersiniabactin-producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit

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