Abstract
Background : We experienced an outbreak of extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae (ESBL-KPN) bacteremia in a neonatal intensive care unit (NICU) starting in August 2017. We implemented an active countermeasure to control the outbreak of ESBL-KPN successfully.
Methods: The incidence of ESBL-KPN based on clinical specimens and healthcare-associated infection (HAI) rate were evaluated before and after the initiation of enhanced infection control (IC) practices initiated in January, 2018. Surveillance cultures were carried out for neonates, medical personnel, and NICU environmental samples. Molecular analyses, including pulse-field gel electrophoresis (PFGE), sequence typing, and ESBL genotyping, were performed for the isolated KPN strains.
Results: The incidence of ESBL-KPN in clinical specimens decreased from 2.84 to 0.49 per 1,000 patient-days and the HAI rate decreased from 2.43 to 0.0 per 1,000 patient-days after the implementation of enhanced IC procedures. Eleven neonates (11/15, 73.3%), one (1/41, 2.4%) of the medical personnel, and six (6/181, 3.3%) samples from the surroundings and medical devices were positive for ESBL-KPN in the surveillance cultures. All isolates demonstrated the same antibiotic resistance pattern and similar PFGE patterns and were identified as ST307 containing CTX-M-15.
Conclusions: Contaminated neonate surroundings and medical devices as well as spreading by medical personnel appeared to be the source of the outbreak of ESBL-KPN. We used an enhanced IC strategy for 3 months and successfully resolved the clonal outbreak of CTX-M-15-producing KPN. ST307 has emerged as an important bacteremia-causing pathogen in the NICU and should be monitored carefully.
Decontamination of Flexible Endoscope : Decontamination by Washer-Disinfector (New Medical Devices Supporting Infection Control )
