Characterization of an outbreak due to extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit

Background: The epidemiological–microbiological characteristics and effective intervention measures in an outbreak due to extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae in a neonatal intensive care unit are described. Materials and methods: Cases from June 22, 2018 to February 11, 2019 were analyzed. Microbiological analysis of intestinal carriage of ESBL-producing K. pneumoniae and environmental samples was conducted. Strain relationships were studied by pulsed-field gel electrophoresis (PFGE). Results: A 35-week outbreak affecting 41 patients, with eight infected, 33 colonized, and two deceased patients occurred. Two stages of the outbreak were observed with differences in the frequency of intestinal carriage of ESBL-producing K. pneumoniae. The same genetic subtype was seen in patient strains and was different from strains isolated from the environment. Deficiencies in contact precautions, hand hygiene, and handling of breast milk were observed. Conclusions: A monoclonal outbreak by ESBL-producing K. pneumoniae that occurred in two phases and the different control measures in each of the stages is described. Effective control measures are mainly based on improving compliance with standard precautions and contact precautions, and other complementary measures are described such as proper handling of breast milk, periodic carriage studies, and the generation of three patient cohorts.

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First outbreak of extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a Norwegian neonatal intensive care unit; associated with contaminated breast milk and resolved by strict cohorting

Apmis ◽

10.1111/j.1600-0463.2012.02879.x ◽

2012 ◽

Vol 120 (8) ◽

pp. 612-621 ◽

Cited By ~ 26

Author(s):

Siren Rettedal ◽

Iren H. Löhr ◽

Olav Natås ◽

Christian G. Giske ◽

Arnfinn Sundsfjord ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Breast Milk ◽

Klebsiella Pneumoniae ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Extended Spectrum

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An Outbreak of Extended-Spectrum β-Lactamase–Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/665715 ◽

2012 ◽

Vol 33 (6) ◽

pp. 631-634 ◽

Cited By ~ 23

Author(s):

Pranita D. Tamma ◽

Patrice Savard ◽

Tibor Pál ◽

Ágnes Sonnevend ◽

Trish M. Perl ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Source Of Infection ◽

Extended Spectrum ◽

Large Outbreak ◽

Invasive Infections

We present a large outbreak of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit that resulted in 31 colonized infants, 10 invasive infections, and 5 attributable deaths over a 5-month period. Although the source of infection was unknown, overcrowding and understaffing appeared to have been aggravating factors.

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Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infection in a neonatal intensive care unit

World Journal of Pediatrics ◽

10.1007/s12519-012-0370-4 ◽

2012 ◽

Vol 8 (3) ◽

pp. 268-271 ◽

Cited By ~ 11

Author(s):

Rong Lin ◽

Bo Wu ◽

Xin-Fen Xu ◽

Xin-Chang Liu ◽

Hong Ye ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Beta Lactamase ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum

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Rapid Eradication of a Cluster ofSerratia marcescensin a Neonatal Intensive Care Unit: Use of Epidemiologic Chromosome Profiling by Pulsed-Field Gel Electrophoresis

Infection Control and Hospital Epidemiology ◽

10.1086/502468 ◽

2004 ◽

Vol 25 (9) ◽

pp. 730-734 ◽

Cited By ~ 17

Author(s):

Kwan Kew Lai ◽

Stephen P. Baker ◽

Sally A. Fontecchio

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Gel Electrophoresis ◽

Neonatal Intensive Care ◽

Pulsed Field Gel Electrophoresis ◽

Control Measures ◽

Pulsed Field ◽

Contact Precautions ◽

Control Study

AbstractObjective:To investigate a cluster of patients infected and colonized withSerratia marcescensin a neonatal intensive care unit (NICU).Methods:In June 2001, two neonates in the NICU had clinical infections withS. marcescensand one died. Infection control surveillance data for the NICU revealed that S.marcescenswas rarely isolated from clinical specimens. Surveillance and environmental cultures were performed and isolates were typed using pulsed-field gel electrophoresis. Staff and neonates were cohorted and a waterless, alcohol-based handwashing agent was introduced. A case-control study was performed.Results:From June 2 through August 20, 2001, 11 neonates withS. marcescensinfection and colonization were identified. The incidence ofS. marcescensinfections increased from 0.19 per 1,000 patient-days in 2000 to 0.52 per 1,000 patient-days in 2001 (P< .0001). In the first 3 weeks of the investigation, there were 2 sets of patients and sinks with indistinguishable strains; however, in subsequent weeks, all isolates were of unique strains, signifying no further transmission of the two initial predominant strains. Neonates withS. marcescenswere more likely to have a lower gestational age and birth weight. There was no association between cases and healthcare workers (HCWs).Conclusions:A cluster ofS. marcescenswas quickly terminated after the introduction of preventive measures including cohorting of infected and colonized neonates and HCWs, contact precautions, surveillance cultures, and a waterless, alcohol-based hand antiseptic. Chromosomal typing determined that strains with an indistinguishable pattern were no longer present in the unit after control measures were implemented.

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