scholarly journals Transmission of a Klebsiella pneumoniae clone harbouring genes for CTX-M-15-like and SHV-112 enzymes in a neonatal intensive care unit of a Kuwaiti hospital

2010 ◽  
Vol 59 (6) ◽  
pp. 687-692 ◽  
Author(s):  
Ali A. Dashti ◽  
Mehrez M. Jadaon ◽  
Huda H. Gomaa ◽  
Bobby Noronha ◽  
Edet E. Udo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Genetic Relatedness ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Klebsiella Pneumonia ◽  
Disc Diffusion

The spread of antibiotic-resistant bacteria has become a large problem in most countries including Kuwait. This antibiotic resistance is usually due to the production of extended-spectrum β-lactamase (ESBL) enzymes such as SHV, TEM and CTX-M. This study reports the emergence and spread of an ESBL-producing Klebsiella pneumoniae clone in a neonatal intensive care unit (NICU) in a Kuwaiti hospital. Eight ESBL-producing K. pneumoniae isolates were from blood cultures of seven neonates, and two were from the fingers of two healthcare workers in a NICU in Al Jahra Hospital, Kuwait. All isolates were obtained in February–March 2006, except for one, which was obtained in August 2005. Identification of the bacteria was based on traditional bacteriological and biochemical tests using the Vitek system. Antibiotic susceptibility was tested by the disc diffusion method using 16 different antibiotics. ESBLs were detected using disc approximation and double-disc synergy methods and confirmed as ESBLs using Etest. PCR and DNA sequencing were performed to determine the genotypes and mutations in the β-lactamase genes (bla TEM, bla SHV and bla CTX-M). Genetic relatedness was determined by PFGE. All isolates were confirmed to have ESBLs by the Vitek system, disc approximation test, double-disc diffusion test and Etest, being resistant to cefotaxime, ceftazidime, cefepime, gentamicin, tobramycin and ciprofloxacin but susceptible to tetracycline and trimethoprim–sulfamethoxazole. Molecular studies showed the isolates to have TEM-1 β-lactamase, a CTX-M-15-like ESBL and the newly discovered SHV-112 ESBL. PFGE showed that all isolates had identical banding patterns. The results indicate that a single clone of ESBL-producing K. pneumoniae caused bloodstream infections among babies in a NICU of a Kuwaiti hospital, and may have emerged at least 5 years ago. This clone was also present on the hands of healthcare workers, suggesting that they may have been involved in its transmission. Further studies are recommended to determine whether this clone is also spreading in other Kuwaiti hospitals.

Genetic Relatedness among Extended-Spectrum β-Lactamase-ProducingKlebsiella pneumoniaeOutbreak Isolates Associated with Colonization and Invasive Disease in a Neonatal Intensive Care Unit

2005 ◽  
Vol 11 (1) ◽  
pp. 21-25 ◽  
Author(s):  
Valéria Câmara De Almeida ◽  
Carmem Lúcia Pessoa-Silva ◽  
Jorge Luiz Mello Sampaio ◽  
Paulo Pinto Gontijo Filho ◽  
Lúcia Martins Teixeira ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Genetic Relatedness ◽  
Invasive Disease ◽  
Extended Spectrum

Control of an Outbreak of Pandrug-ResistantAcinetobacter baumanniiColonization and Infection in a Neonatal Intensive Care Unit

2007 ◽  
Vol 28 (4) ◽  
pp. 423-429 ◽  
Author(s):  
Pei-Chun Chan ◽  
Li-Min Huang ◽  
Hui-Chi Lin ◽  
Luan-Yin Chang ◽  
Mei-Ling Chen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Neonatal Intensive Care Unit ◽  
Active Surveillance ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Control Measures ◽  
Positive Culture Result ◽  
Mode Of Transmission

Objective.To investigate the potential reservoir and mode of transmission of pandrug-resistant (PDR)Acinetobacter baumanniiin a 7-day-old neonate who developed PDRA. baumanniibacteremia that was presumed to be the iceberg of a potential outbreak.Design.Outbreak investigation based on a program of prospective hospital-wide surveillance for nosocomial infection.Setting.A 24-bed neonatal intensive care unit in a 2,200-bed major teaching hospital in Taiwan that provides care for critically ill neonates born in this hospital and those transferred from other hospitals.Interventions.Samples from 33 healthcare workers' hands and 40 samples from the environment were cultured. Surveillance cultures of anal swab specimens and sputum samples were performed for neonates on admission to the neonatal intensive care unit and every 2 weeks until discharge. The PDRA. baumanniiisolates, defined as isolates resistant to all currently available systemic antimicrobials except polymyxin B, were analyzed by pulsed-field gel electrophoresis. Control measures consisted of implementing contact isolation, reinforcing hand hygiene adherence, cohorting of nurses, and environmental cleaning.Results.One culture of an environmental sample and no cultures of samples from healthcare workers' hands grew PDRA. baumannii. The positive culture result involved a sample obtained from a ventilation tube used by the index patient. During the following 2 months, active surveillance identified PDRA. baumanniiin 8 additional neonates, and isolates from 7 had the same electrokaryotype. Of the 9 neonates colonized or infected with PDRA. baumannii, 1 died from an unrelated condition. Reinforcement of infection control measures resulted in 100% adherence to proper hand hygiene protocol. The outbreak was stopped without compromising patient care.Conclusions.In the absence of environmental contamination, transient hand carriage by personnel who cared for neonates colonized or infected with PDRA. baumanniiwas suspected to be the mode of transmission. Vigilance, prompt intervention and strict adherence to hand hygiene protocol were the key factors that led to the successful control of this outbreak. Active surveillance appears to be an effective measure to identify potential transmitters and reservoirs of PDRA. baumannii.

scholarly journals An Outbreak of Burkholderia Cepacia Septicemia in Neonatal Intensive Care Unit of a Tertiary Care Hospital, Peshawar

2021 ◽  
Author(s):  
Muhammad Abdullah ◽  
Maria Khan ◽  
Danyal Amjad ◽  
Farah Shireen ◽  
Shah masoom ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Burkholderia Cepacia ◽  
Neonatal Intensive Care ◽  
Physiological State ◽  
Tertiary Care ◽  
Diffusion Method ◽  
Care Hospital ◽  
Blood Samples

Abstract Background: Burkholderia cepacia (formerly Pseudomonas) is a gram-negative bacillus that can remain viable in low-nutrient water and is typically found in soil and moist settings. It is one of the leading causes of sepsis in infants, and it is spread by human contact with contaminated medical devices and disinfectants. B. cepacia has emerged as a significant opportunistic pathogen in hospitalized and immunocompromised patients, colonizing the lungs of individuals with cystic fibrosis. Hospital outbreaks have been associated to infected faucets, nebulizers, disinfection solutions, multi-dose antibiotic vials, drinking water, distilled water, flowmeters, nasal sprays, and ultrasound gels. We describe our investigation and successful management of a nosocomial Burkholderia cepacia sepsis outbreak in a tertiary care hospital's newborn intensive care unit in Peshawar, Pakistan.Methodology: Blood samples from 50 newborns with sepsis were collected using a standardized approach and incubated using an automated blood culture system (BACT/Alert 3D and BACTEC 9050). Disk diffusion and the Minimum inhibitory concentration methods were used to test antimicrobial susceptibility. Gram staining was used to identify bacteria, and API (Analytical Profile Index) 20 NE was used to characterize them biochemically. Environmental and epidemiological investigations were also conduct to investigate the source and route of infection.Results: All of the 50 patients admitted in NICU (Neonatal Intensive Care Unit) were included in this study, and had lately-onset neonatal sepsis, with B. cepacia. During an epidemic in the NICU from 30th, April to 21st, June 2021, B. cepacia was isolated from over 45 blood samples. In total 45 neonates 17(35%) were female and 28 (65%) were male. Average age of neonates was 14.88 days. Antibiotic susceptibility testing was performed on Muller Hinton agar using Kirby Bauer's disc diffusion method and interpreted according to Clinical Laboratory Standard Institute (CLSI 2021) guidelines. As B. cepacia has intrinsic resistant to polymyxin class (colistin sulphate) of antibiotics, the susceptibility pattern of all isolates were almost similar i.e. showing resistance to tetracycline 100% (minocycline) and cephalosporin 3rd generation 100% (ceftazidime). The isolates were 100% sensitive to fluoroquinolones (levofloxacin), carbapenem 100% (meropenem), chloramphenicol 100% and sulfonamide 100% (co trimaxazole).Conclusion: In present study, the index case might have been exposed to infection due to an intravenous fluid utilized for fluid and electrolyte replacement for intravenous delivery were the source of the current nosocomial outbreak and physiological state of low immunity (preterm, low birth weight, and mechanical ventilation). The rest of the cases might have been exposed to this organism due to inadequate hand hygiene/improper cleaning and disinfection practices. Timely reporting and implementation of infection control measures can play a significant role in curtailing this outbreak.

scholarly journals Survey of Knowledge, Beliefs, and Practices of Neonatal Intensive Care Unit Healthcare Workers Regarding Nosocomial Infections, Central Venous Catheter Care, and Hand Hygiene

2004 ◽  
Vol 25 (9) ◽  
pp. 747-752 ◽  
Author(s):  
Allison M. Kennedy ◽  
Alexis M. Elward ◽  
Victoria J. Fraser
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Venous Catheter ◽  
Central Venous ◽  
Gram Negative ◽  
Beliefs And Practices ◽  
Knowledge And Beliefs

AbstractObjective:To assess the knowledge, beliefs, and practices of neonatal intensive care unit (NICU) healthcare workers (HCWs).Design:Self-administered survey.Setting:A 55-bed NICU.Participants:NICU HCWs (N = 215).Results:The response rate was 68%. Ninety-two percent knew central venous catheters (CVCs) should be capped, clamped, or connected to running fluids at all times. Ninety-five percent knew when to change gloves. Thirty-one percent knew the recommended duration for handwashing. Most HCWs believed sterile technique in CVC care (96%), gloves (91%), and handwashing (99%) prevent nosocomial infection (NI). Sixty-seven percent used sterile barriers to insert CVCs, 76% reported wearing gloves, 81% reported routine handwashing, 35% knew that bacterial hand counts are higher with rings, 30% knew that long fingernails are associated with higher gram-negative bacterial hand contamination, and 35% knew that artificial fingernails are associated with higher gram-negative bacterial hand contamination. Most (93%) believed HCWs can affect outcomes of patients with NIs. Fewer believed rings (40%), artificial fingernails (61%), and long fingernails (48%) play a role in NIs, or that policies concerning number of rings (50%), cutting fingernails (35%), or prohibiting artificial fingernails (47%) would prevent NIs. Sixty-one percent of HCWs regularly wore at least one ring to work, 56% wore their fingernails shorter than the fingertip, and 8% wore artificial fingernails.Conclusions:A disconnect existed between CVC knowledge and beliefs and practice. HCWs did not know the relationship between bacterial hand counts and rings and fingernails, and did not believe rings or long or artificial fingernails increased the risk of NIs.

scholarly journals Optical DNA Mapping Combined with Cas9-Targeted Resistance Gene Identification for Rapid Tracking of Resistance Plasmids in a Neonatal Intensive Care Unit Outbreak

mBio ◽  
2019 ◽  
Vol 10 (4) ◽  
Author(s):  
Santosh K. Bikkarolla ◽  
Viveka Nordberg ◽  
Fredrika Rajer ◽  
Vilhelm Müller ◽  
Muhammad Humaun Kabir ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Resistant Bacteria ◽  
Content Type ◽  
Dna Mapping ◽  
Global Spread ◽  
Resistance Plasmids

ABSTRACTThe global spread of antibiotic resistance amongEnterobacteriaceaeis largely due to multidrug resistance plasmids that can transfer between different bacterial strains and species. Horizontal gene transfer of resistance plasmids can complicate hospital outbreaks and cause problems in epidemiological tracing, since tracing is usually based on bacterial clonality. We have developed a method, based on optical DNA mapping combined with Cas9-assisted identification of resistance genes, which is used here to characterize plasmids during an extended-spectrum β-lactamase (ESBL)-producingEnterobacteriaceaeoutbreak at a Swedish neonatal intensive care unit. The outbreak included 17 neonates initially colonized with ESBL-producingKlebsiella pneumoniae(ESBL-KP), some of which were found to carry additional ESBL-producingEscherichia coli(ESBL-EC) in follow-up samples. We demonstrate that all ESBL-KP isolates contained two plasmids with theblaCTX-M-15gene located on the smaller one (~80 kbp). The same ESBL-KP clone was present in follow-up samples for up to 2 years in some patients, and the plasmid carrying theblaCTX-M-15gene was stable throughout this time period. However, extensive genetic rearrangements within the second plasmid were observed in the optical DNA maps for several of the ESBL-KP isolates. Optical mapping also demonstrated that even though other bacterial clones and species carryingblaCTX-Mgroup 1 genes were found in some neonates, no transfer of resistance plasmids had occurred. The data instead pointed toward unrelated acquisition of ESBL-producingEnterobacteriaceae(EPE). In addition to revealing important information about the specific outbreak, the method presented is a promising tool for surveillance and infection control in clinical settings.IMPORTANCEThis study presents how a novel method, based on visualizing single plasmids using sequence-specific fluorescent labeling, could be used to analyze the genetic dynamics of an outbreak of resistant bacteria in a neonatal intensive care unit at a Swedish hospital. Plasmids are a central reason for the rapid global spread of bacterial resistance to antibiotics. In a single experimental procedure, this method replaces many traditional plasmid analysis techniques that together provide limited details and are slow to perform. The method is much faster than long-read whole-genome sequencing and offers direct genetic comparison of patient samples. We could conclude that no transfer of resistance plasmids had occurred between different bacteria during the outbreak and that secondary cases of ESBL-producingEnterobacteriaceaecarriage were instead likely due to influx of new strains. We believe that the method offers potential in improving surveillance and infection control of resistant bacteria in hospitals.

Nosocomial Pulmonary Tuberculosis Contact Investigation in a Neonatal Intensive Care Unit

2013 ◽  
Vol 34 (7) ◽  
pp. 754-756 ◽  
Author(s):  
Kate E. Fisher ◽  
Robert Guaran ◽  
Jacqueline Stack ◽  
Sheila Simpson ◽  
William Krause ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pulmonary Tuberculosis ◽  
Neonatal Intensive Care Unit ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Medical Officer ◽  
Tuberculosis Transmission ◽  
Contact Investigation ◽  
Smear Positive Pulmonary Tuberculosis

The diagnosis of smear-positive pulmonary tuberculosis in a medical officer working in a metropolitan Australian neonatal intensive care unit led to a contact investigation involving 125 neonates, 165 relatives, and 122 healthcare workers with varying degrees of exposure. There was no evidence of nosocomial tuberculosis transmission from the index case.

A Prolonged Outbreak ofPseudomonas Aeruginosain a Neonatal Intensive Care Unit Did Staff Fingernails Play a Role in Disease Transmission?

2000 ◽  
Vol 21 (2) ◽  
pp. 80-85 ◽  
Author(s):  
Ronald L. Moolenaar ◽  
J. Michael Crutcher ◽  
Venusto H. San Joaquin ◽  
Lucille V. Sewell ◽  
Lori C. Hutwagner ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Disease Transmission ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Multivariate Logistic Regression Analysis ◽  
Hospital Acquired ◽  
Control Study ◽  
Genotype A

AbstractObjectives:To describe an outbreak ofPseudomonas aeruginosabloodstream infection (BSD and endotracheal tube (ETT) colonization in a neonatal intensive care unit (NICU), determine risk factors for infection, and make preventive recommendations.Design:A 15-month cohort study followed by a case-control study with an environmental survey and molecular typing of available isolates using pulsed-field gel electrophoresis.Setting and Patients:Neonates in the NICU of a university-affiliated children's hospital.Interventions:Improved hand washing and restriction of use of long or artificial fingernails.Results:Of 439 neonates admitted during the study period, 46 (10.5%) acquiredP aeruginosa; 16 (35%) of those died. Fifteen (75%) of 20 patients for whom isolates were genotyped had genotype A and 3 (15%) had genotype B. Of 104 healthcare workers (HCWs) from whom hand cultures were obtained,P aeruginosawas isolated from three nurses. Cultures from nurses A-1 and A-2 grew genotype A and cultures from nurse B grew genotype B. Nurse A-1 had long natural fingernails, nurse B had long artificial fingernails, and nurse A-2 had short natural fingernails. On multivariate logistic regression analysis, exposure to nurse A-l and exposure to nurse B were each independently associated with acquiring a BSI or ETT colonization withP aeruginosa, but other variables, including exposure to nurse A-2, were not.Conclusion:Epidemiological evidence demonstrated an association between acquiringP aeruginosaand exposure to two nurses. Genetic and environmental evidence supported that association and suggested, but did not prove, a possible role for long or artificial fingernails in the colonization of HCWs' hands withP aeruginosa. Requiring short natural fingernails in NICUs is a reasonable policy that might reduce the incidence of hospital-acquired infections.

scholarly journals Neonatal Exposure to Staphylococcus aureus in the Neonatal Intensive Care Unit: Identifying Reservoirs Among Colonized Healthcare Workers and Parents

2020 ◽  
Vol 41 (S1) ◽  
pp. s490-s491
Author(s):  
Jennifer Lee ◽  
Annie Voskertchian ◽  
Danielle Koontz ◽  
Karen Carroll ◽  
Tracy Howard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Nurse Practitioners ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Invasive Disease ◽  
Becton Dickinson ◽  
Anatomic Locations

Background:Staphylococcus aureus (S. aureus) is the second most common cause of healthcare-acquired infections in neonates. S. aureus colonization is a known risk factor for invasive disease. Aside from healthcare workers (HCWs), recent data suggest that parents are important reservoirs of S. aureus in the neonatal intensive care unit (NICU). S. aureus typically colonizes the nares, but it can also colonize other anatomic locations such as the throat. Objective: Our objectives were to identify and compare S. aureus colonization among HCWs and parents and to identify and compare different sites of S. aureus colonization. Methods: Between April 2015 and July 2016, we performed 4 point-prevalence surveys and collected nares and throat swabs from HCWs (nurses, respiratory therapists, nurse practitioners, and physicians) at a quaternary-care NICU. During an overlapping period, we screened parents of neonates in the NICU for S. aureus colonization using nares, throat, groin, and perianal cultures as a part of an ongoing randomized control trial. Cultures from both studies were collected using standardized methods. ESwabs were used to collect samples, which were inoculated into broth for enrichment and subsequently cultured onto chromogenic agar to differentiate between MSSA and MRSA. Results: The prevalence of methicillin susceptible S. aureus (MSSA) colonization was 46% (105/226) in HCWs and 28% (239/842) in parents. The prevalence of methicillin resistant S. aureus (MRSA) colonization was 2.2% (5/226) in HCWs and 2.2% (19/842) in parents. Of those who were colonized with S. aureus, 35% (79/226) of HCWs and 46.5% (160/344) of parents had nares and throat colonization while 11.5% (26/226) of HCWs and 12.2% (42/344) of parents had only throat colonization but not nares colonization. Of those who were MRSA colonized, 1.3% (3/226) of HCWs and 1.8% (15/842) of parents had a positive nares and throat culture as compared to 0.9% (2/226) of HCWs and 0.2% (2/842) of parents had only positive throat cultures. Additionally, 68% (175/257) were colonized with S. aureus at any swabbed site including nares, throat, groin, or perinanal areas. However, only 30% (77/257) of parents had only nares colonization as compared to 58.8% (151/257) had throat and nares colonization, 38.1% (98/257) had nares and groin colonization, and 37.4% (96/257) had nares and perianal colonization. Conclusions: HCWs had greater prevalence of S. aureus colonization compared to parents. As expected, the nares was the most common site of MSSA and MRSA, but a large proportion of S. aureus colonized HCWs and parents had only throat colonization. Given the prevalence of S. aureus in non-nares sites of HCWs and parents in the NICU, further studies should examine the role of non-nares carriers in the transmission of S. aureus in this population.Funding: NoneDisclosures: Aaron Milstone reports consultancy with Becton Dickinson.

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