Multiresistant Klebsiella pneumoniae in a neonatal nursery: the importance of maintenance of infection control policies and procedures in the prevention of outbreaks

Coovadia, Y.M.; Johnson, Alan P.; Bhana, R.H.; Hutchinson, G R; George, R.C.; Hafferjee, I.E.

doi:10.1016/0195-6701(92)90044-m

Cited by 88 publications

(45 citation statements)

References 17 publications

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“…These factors were found to be not statistically significant in our study. Most neonatologists do not recommend prophylactic use of antimicrobial agents in many of these risk factors, but rather start them at the earliest definite indication of sepsis [1,4,6,7,[14][15][16]. We strongly support this view.…”

Section: Discussionsupporting

confidence: 71%

“…Also despite advances in various aspects of neonatal medical practices, and the impoved overall survival, infections remain a serious cause of morbidity and mortality [1][2][3]. Clinicians' awareness of this problem might have increased the tendency for excessive use of antimicrobial agents, hence almost all critically ill neonates receive antimicrobials during their hospital stay, close to 90% in some reported series [4,5]. This phenomenon has resulted in increasing resistance of nosocomial pathogens in the neonatal intensive care units all over the world [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Misuse of Antimicrobial Agents in Neonatal Units: A Cross-Sectional Survey in Kuwait

et al. 1999

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Objective: To evaluate the justification for the use of antimicrobial agents and to verify the possibility of its misuse among inpatient neonates. Methods: A cross-sectional 1-day study was conducted. Two questionnaires A and B relating to inpatient neonates were filled by registrars working in the four neonatal units of the main regional hospitals (Maternity, Farwaniya, Adan, and Jahra). The objectives of the study were not revealed to the registrars. Results: Of the 119 patients, 57 (48%) were on antimicrobial agents, and the cultures yielded positive in 25/57 (44%). The organisms were reported not to be susceptible to the antimicrobial agents in use in 19/25 (76%) of the cases, but it was continued in 4/19 (21%). Antimicrobial agents were also continued in another 9/32 (28%) despite negative culture results. Conclusion: Misuse of antimicrobial agents was homogeneously observed at various levels in all neonatal units. This implies that urgent action should be taken to overcome this problem.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Misuse of Antimicrobial Agents in Neonatal Units: A Cross-Sectional Survey in Kuwait

et al. 1999

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“…Outbreaks caused by successful clones of ESCRKP have been reported since the early 1990s for NICUs in several countries (3)(4)(5). Production of extended-spectrum ␤-lactamases (ESBLs) is the most common mechanism of ESC resistance in K. pneumoniae, and most of the ESCRKP outbreaks reported for NICU settings have been caused by ESBL-producing strains (6)(7)(8)(9)(10)(11)(12)(13)(14).…”

mentioning

confidence: 99%

Large Oligoclonal Outbreak Due to Klebsiella pneumoniae ST14 and ST26 Producing the FOX-7 AmpC β-Lactamase in a Neonatal Intensive Care Unit

et al. 2013

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A large outbreak caused by expanded-spectrum cephalosporin-resistant Klebsiella pneumoniae (ESCRKP) was observed in a neonatal intensive care unit (NICU) in central Italy. The outbreak involved 127 neonates (99 colonizations and 28 infections, with seven cases of sepsis and two deaths) over a period of more than 2 years (February 2008 to April 2010). Characterization of the 92 nonredundant isolates that were available for further investigation revealed that all of them except one produced the FOX-7 AmpC-type ␤-lactamase and belonged to either sequence type 14 (ST14) or ST26. All of the FOX-7-positive isolates were resistant to cefotaxime, ceftazidime, and piperacillin-tazobactam, while 76% were susceptible to cefepime, 98% to ertapenem, 99% to meropenem, and 100% to imipenem. The two carbapenem-nonsusceptible isolates had alterations in the genes encoding outer membrane proteins K35 and K36, which resulted in truncated and likely nonfunctional proteins. The outbreak was eventually controlled by the reinforcement of infection control measures based on a multitiered interventional approach. This is the first report of a large NICU outbreak caused by ESCRKP producing an AmpC-type enzyme. This study demonstrates that AmpCtype enzyme-producing strains can cause large outbreaks with significant morbidity and mortality effects (the mortality rate at 14 days was 28.5% for episodes of sepsis), and it underscores the role of laboratory-based surveillance and infection control measures to contain similar episodes.

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“…2,26,27 However, there were sporadic cases in some wards where there had been no movement of patients from other wards. In regard to the causes of infection with bacteria, outbreaks caused by contamination of tracheal tubes 28 and transmission from the hands of medical staff 28 have been reported. In the present study, in 4 of the 11 patients with pneumonia, tracheal absorption tubes or margen tubes had been used, and, in all the patients with urinary tract infection, a urethral catheter had been used, while in the two patients with sepsis, a blood catheter had been used .…”

Section: Discussionmentioning

confidence: 99%

Hospital outbreak of MEN-1-derived extended spectrum β-lactamase-producing Klebsiella pneumoniae

Komatsu

Ikeda

Aihara

et al. 2001

Journal of Infection and Chemotherapy

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Multiresistant Klebsiella pneumoniae in a neonatal nursery: the importance of maintenance of infection control policies and procedures in the prevention of outbreaks

Cited by 88 publications

References 17 publications

Misuse of Antimicrobial Agents in Neonatal Units: A Cross-Sectional Survey in Kuwait

Misuse of Antimicrobial Agents in Neonatal Units: A Cross-Sectional Survey in Kuwait

Large Oligoclonal Outbreak Due to Klebsiella pneumoniae ST14 and ST26 Producing the FOX-7 AmpC β-Lactamase in a Neonatal Intensive Care Unit

Hospital outbreak of MEN-1-derived extended spectrum β-lactamase-producing Klebsiella pneumoniae

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