Risk factors for extended-spectrum β-lactamase-producing Serratia marcescens and Klebsiella pneumoniae acquisition in a neonatal intensive care unit

Crivaro, Valeria; Bagattini, Maria; Salza, M.F.; Raimondi, Francesco; Rossano, F.; Triassi, Maria; Zarrilli, Raffaele

doi:10.1016/j.jhin.2007.07.026

Cited by 87 publications

(76 citation statements)

References 18 publications

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“…Moreover, total parenteral nutrition and mechanical ventilation were significant predictors of ESBL K. pneumoniae infections, 23 and total days of hospital stay proved to be an independent risk factor for acquisition, suggesting that the hospital environment plays a crucial role in the transmission of such pathogens. 3,24 In contrast to our findings, previous studies have demonstrated that low birth weight 5 and mechanical ventilation 3,5 were not independent predictors of ESBL K. pneumoniae infection. The differences between our study and other studies probably could be related to differences in respiratory, nutritional and nursing practices.…”

Section: Discussioncontrasting

confidence: 99%

RETRACTED ARTICLE: Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

et al. 2008

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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

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Section: Discussioncontrasting

confidence: 99%

RETRACTED ARTICLE: Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

et al. 2008

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“…Moreover, antibiotic-resistant bacteria, such as Staphylococcus aureus and Klebsiella pneumonia have caused serious and life-threatening infections in immunocompromised hosts, including neonates [52,53]. The development of novel therapeutic approaches against drug-resistant bacterial infection is an urgent problem.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D3 induces expression of human cathelicidin antimicrobial peptide 18 in newborns

et al. 2009

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Bactericidal activities of neutrophils occur by two distinctive mechanisms that are oxygen-dependent and -independent. Human cathelicidin antimicrobial peptide 18 (hCAP18), also known as LL-37/FALL-39, is a neutrophil-specific granule protein. We compared the content of hCAP18 and neutrophil gelatinase-associated lipocalin (NGAL), another neutrophil-specific granule protein, in neutrophils of both neonates and adults by flow cytometry. The percentage as well as fluorescence intensity ratio of hCAP18 and NGAL expression in neonate neutrophils were significantly lower than in adults. Expression of hCAP18 in monocytes, however, was not significantly different between neonates and adults. Both hCAP18 and NGAL expression increased in an age-dependent fashion. Plasma concentration of these peptides measured by enzyme-linked immunosorbent assay was not significantly different between neonates and adults. Oral intake of 1a hydroxy vitamin D 3 (1a(OH)D 3 ) in rickets patients for 4 weeks significantly increased hCAP18 expression in neutrophils compared to age-matched healthy controls without 1a(OH)D 3 , indicating the potential of vitamin D 3 as a regulator of the innate immune response of neonates.

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“…In addition, they determined that the following precautions should be followed if an S. marcescens outbreak is suspected: patients should be isolated, barrier precautions should be utilized, antibiotic therapy should be guided by susceptibility testing and not empirically, and environmental sampling for S. marcescens should be performed only if the institution of barrier precautions does not contain the outbreak (398). Voelz and others determined that risk factors for S. marcescens outbreaks include exposure to hands of health care workers, length of hospital stay, and use of antibiotics that may eliminate the normal flora of a patient, similar to those often ascertained for outbreaks that have occurred among adults in hospitals (94,137,398).…”

Section: S Marcescensmentioning

confidence: 96%

“…There are several reports of ESBL-expressing S. marcescens isolates. In some cases, ESBL-expressing S. marcescens strains have caused outbreaks (94,196,281,284,293). S. marcescens strains most commonly carry CTX-M-type ESBLs (69,196,218,273,284,293,295,414,421) but have also been found carrying SHV (218,281,284,295), TEM (218,284,295), and a novel ESBL, BES-1 (42).…”

Section: ␤-Lactam Resistance In Serratia Speciesmentioning

confidence: 99%

Serratia Infections: from Military Experiments to Current Practice

2011

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SUMMARY Serratia species, in particular Serratia marcescens , are significant human pathogens. S. marcescens has a long and interesting taxonomic, medical experimentation, military experimentation, and human clinical infection history. The organisms in this genus, particularly S. marcescens , were long thought to be nonpathogenic. Because S. marcescens was thought to be a nonpathogen and is usually red pigmented, the U.S. military conducted experiments that attempted to ascertain the spread of this organism released over large areas. In the process, members of both the public and the military were exposed to S. marcescens , and this was uncovered by the press in the 1970s, leading to U.S. congressional hearings. S. marcescens was found to be a certain human pathogen by the mid-1960s. S. marcescens and S. liquefaciens have been isolated as causative agents of numerous outbreaks and opportunistic infections, and the association of these organisms with point sources such as medical devices and various solutions given to hospitalized patients is striking. Serratia species appear to be common environmental organisms, and this helps to explain the large number of nosocomial infections due to these bacteria. Since many nosocomial infections are caused by multiply antibiotic-resistant strains of S. marcescens , this increases the danger to hospitalized patients, and hospital personnel should be vigilant in preventing nosocomial outbreaks due to this organism. S. marcescens , and probably other species in the genus, carries several antibiotic resistance determinants and is also capable of acquiring resistance genes. S. marcescens and S. liquefaciens are usually identified well in the clinical laboratory, but the other species are rare enough that laboratory technologists may not recognize them. 16S rRNA gene sequencing may enable better identification of some of the less common Serratia species.

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Risk factors for extended-spectrum β-lactamase-producing Serratia marcescens and Klebsiella pneumoniae acquisition in a neonatal intensive care unit

Cited by 87 publications

References 18 publications

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

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

Vitamin D3 induces expression of human cathelicidin antimicrobial peptide 18 in newborns

Serratia Infections: from Military Experiments to Current Practice

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