Outbreak of pulmonary infection caused by Klebsiella pneumoniae isolates harbouring bla and bla DHA-1 in a neonatal intensive care unit in China Outbreaks caused by Klebsiella pneumoniae producing carbapenemases and other blactamases have been reported. Four neonates admitted to a neonatal intensive care unit (NICU) in a Chinese hospital developed respiratory infection while receiving intensive care. In all four cases, multidrug-resistant K. pneumoniae was isolated from multiple respiratory specimens, leading to additional characterization of these organisms and investigation of the local environment in the NICU. Multiple b-lactamase genes, including bla TEM-1 , bla IMP-4 , bla DHA-1 and bla CTX-M-14 , as well as the quinolone resistance gene qnrB4, were harboured by transferable plasmids from all four clinical isolates. Furthermore, PFGE confirmed that three of the four clinical isolates from the patients and three K. pneumoniae isolates collected from the hands of healthcare workers and an incubator in the NICU belonged to the same PFGE cluster, indicating that an outbreak due to multidrug-resistant K. pneumoniae carrying bla IMP-4 and bla DHA-1 occurred in this NICU. As far as is known, this is the first report of the co-existence of bla IMP-4 and bla DHA-1 in the same K. pneumoniae isolate. These data suggest that additional precautions are needed to prevent outbreaks of infection caused by multidrug-resistant K. pneumoniae resulting from environmental exposure in NICUs. INTRODUCTIONKlebsiella pneumoniae frequently exhibits resistance to extended-spectrum cephalosporins due to the production of extended-spectrum b-lactamases (ESBLs) (Falagas & Karageorgopoulos, 2009

BackgroundThere is a lack of data regarding the prevalence of invasive group B streptococcus (GBS) infection among neonates in China. This study aimed to investigate the incidence and mortality of invasive GBS infection and to identify the risk factors in our hospital.MethodsSeventy-four cases admitted between January 2011 and December 2016 was included in this study. A retrospective matched case-control study was conducted in a tertiary maternity and paediatric hospital. Risk factors for the acquisition of invasive GBS infection and mortality were analysed by univariable and multivariable analysis.ResultsWe collected and analysed data from 74 infants aged < 3 months with invasive GBS infection. Among 67,985 live births, we calculated an incidence of 1.09 per 1000 live births (95%CI:0.81–1.37%); the incidence of Early-onset GBS disease (EOD, n = 65) and Late-onset GBS disease (LOD, n = 9) were 0.96‰(95%CI:0.73–1.19%) and 0.13‰(95%CI:0.04–0.22%), respectively. Overall, pneumonia accounted 63.1% (41/65) of EOD, and sepsis accounted 88.9% (8/9) cases of LOD, respectively. The overall case fatality rate was 8.11% (6/74), including 7.69% (5/65) among cases of EOD and 11.1% (1/9) among cases of LOD. No predictor of mortality was found. Membrane stripping (P = 0.005, aOR: 3.68, 95% CI: 1.48–9.13) and non-resident mother (P < 0.001, aOR: 5.88, 95% CI: 2.36–14.61) were independent risk factors for EOD; no increased risk was found for LOD.ConclusionsThis study demonstrates remarkable country-specific variation in comparison with other countries. Our findings can improve awareness of neonatal GBS infection and lay a cornerstone to ensure accurate representation of the burden.

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Background: The detection rate and drug resistance rate of K. pneumoniae increased year by year in China. Understanding the drug resistance situation will help guide prevention and control of K. pneumoniae infection. Methods: This study collected the results of drug susceptibility of K. pneumoniae from six tertiary hospitals in Shaoxing city in 2019 and analyzed the differences in drug resistance among different hospitals, genders, ages, and specimens. Results: A total of 1954 strains were collected, all of which were most sensitive to amikacin, with a resistance rate of 4.42%. The resistance rate to carbapenems and tigecycline was less than 10%. Nitrofurantoin had the highest resistance rate (36.18%). The drug resistance rate of Shaoxing traditional Chinese medicine hospital and Shaoxing maternity and child health care hospital was lower, and the drug resistance rate of the affiliated hospital of Shaoxing University was the highest. In addition to the Shaoxing maternity and child health care hospital, specimens were mainly from elderly and male patients, the drug resistance rate increased with age, and no carbapenem-resistant strains were found in patients under 17 years old. The specimens were mostly from the respiratory tract and urinary tract, but the CRKP rate was the highest in blood, the ESBL rate was the highest in other sterile body fluids except for blood, and the high ESBL and CR rates in urine were also detected. Conclusions: The above results indicated that there were significant differences in drug resistance rates of strains among different hospitals, genders, ages, and specimen sources, and clinical empirical medication should be incorporated into the reference.

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