RETRACTED ARTICLE: Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

Abstract

Objectives: Extended-spectrum beta-lactamase producing (ESBL) Klebsiella pneumoniae is an important cause of nosocomial infections in neonatal intensive care units (NICUs). Our objectives were to determine (1) the incidence of ESBL K. pneumoniae in our NICU, (2) the frequency of SHV-1 and SHV-2 gene acquisition among ESBL K. pneumoniae isolates, (3) the risk factors associated with ESBL K. pneumoniae infection and (4) the clinical outcomes of infected infants.Study Design: We conducted a prospective surveillance study in our NICU over a period of 1 year on all neonates admitted without evidence of early sepsis. We collected specimens from blood, urine, cerebrospinal fluid, swabs from wounds and throat and endotracheal tube aspirates of infants whenever sepsis was suspected. Bacterial isolates were identified via clinical morphology, Gram stain and standard biochemical tests. Antimicrobial susceptibility was determined by disc diffusion method, and phenotypic confirmation of ESBL production was done by the double-disc synergy test and Etest. Genetic detection of SHV-1 and SHV-2 genes in ESBL K. pneumoniae isolates was done by polymerase chain reaction (PCR) and restriction fragment length polymorphisms. Risk factors associated with ESBL K. pneumoniae infection were analysed by both univariate and multiple logistic regression methods.Results: A total of 980 cultures were obtained from 380 neonates, and 372 screening cultures were collected from the environment. K. pneumoniae was cultured from 27 (7%) infants (3.8/1000 patient-days); of them, 18 (67%) were ESBL producers. PCR amplicons revealed the presence of SHV-2 in all 18 isolates (100%), and SHV-1 gene in 8 isolates (44%). Independent risk factors for ESBL K. pneumoniae infection were mechanical ventilation (OR: 4.2, confidence interval (CI): 1.6-11.0); birth weight <1500 g (OR: 3.2, CI: 1.2-8.3) ); duration of hospitalization >15 days (OR: 4

Molecular determinants of ß-lactamase producing Klebsiella pneumoniae in MansouraUniversity Neonatal Intensive Care Unit

“…Higher ESBL production of K. pneumoniae clinical isolates (67%) was also reported by Abdel-Hady et al (19) in Egyptian neonates hospitalized in ICU. However, a much lower incidence (2.97%) was reported by Romero et al(20) in Spanish patients and healthy person.…”

Large Oligoclonal Outbreak Due to Klebsiella pneumoniae ST14 and ST26 Producing the FOX-7 AmpC β-Lactamase in a Neonatal Intensive Care Unit

“…This probably reflects the overall lower prevalence of pACBLs versus ESBLs among Enterobacteriaceae, although the difficulties in pACBL detection encountered in the clinical microbiology laboratory also could contribute to underestimation of the circulation of these resistance determinants. This report also shows that the clinical impact of pACBLproducing K. pneumoniae can be comparable to that of ESBLproducing K. pneumoniae (10).…”

“…Production of extended-spectrum ␤-lactamases (ESBLs) is the most common mechanism of ESC resistance in K. pneumoniae, and most of the ESCRKP outbreaks reported for NICU settings have been caused by ESBL-producing strains (6)(7)(8)(9)(10)(11)(12)(13)(14). Production of other ␤-lactamases, such as AmpC-type ␤-lactamases (ACBLs), can also be responsible for ESC-resistant phenotypes in K. pneumoniae, but the number of reported outbreaks caused by AmpCproducing ESCRKP is considerably more limited.…”

Microbiological assessment of indoor air of a teaching hospital in Nigeria

“…Organisms that are often associated with hospital acquired infections are Staphylococcus aureus, Micrococcus sp., Pseudomonas sp., Proteus sp., Escherichia coli, Enterobacter, Bacillus cereus, Cladosporium sp., Aspergillus sp., and viruses [9,10] . Pseudomonas aeruginosa has been particularly incriminated in nosocomial infection because of its intrinsic resistance to most antibiotics and its ability to survive and multiply at low temperatures and in disinfectant solutions [11] .…”