Prompt Control of an Outbreak Caused by Extended-Spectrum [beta]-Lactamase-Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit.
Cantey, Joseph B. MD 1; Sreeramoju, Pranavi MD 2,3; Jaleel, Mambarambath MD 1; Trevino, Sylvia MT 3; Gander, Rita PhD 4; Hynan, Linda S. PhD 5; Hill, Jennifer BSN 6; Brown, Cari BSN 6; Chung, Wendy MD, MPH 7; Siegel, Jane D. MD 1; Sanchez, Pablo J. MD 1,*
[Article]
Journal of Pediatrics.
163(3):672-679e3, September 2013.
(Format: HTML, PDF)
Objectives: To assess the effectiveness of a set of multidisciplinary interventions aimed at limiting patient-to-patient transmission of extended-spectrum [beta]-lactamase-producing Klebsiella pneumoniae (ESBL-KP) during a neonatal intensive care unit (NICU) outbreak, and to identify risk factors associated with ESBL-KP colonization and disease in this setting.
Study design: A 61-infant cohort present in the NICU during an outbreak of ESBL-KP from April 26, 2011, to May 16, 2011, was studied. Clinical characteristics were compared in infected/colonized infants and unaffected infants. A multidisciplinary team formulated an outbreak control plan that included (1) staff reeducation on recommended infection prevention measures; (2) auditing of hand hygiene and environmental services practices; (3) contact precautions; (4) cohorting of infants and staff; (5) alleviation of overcrowding; and (6) frequent NICU-wide screening cultures. Neither closure of the NICU nor culturing of health care personnel was instituted.
Results: Eleven infants in this level III NICU were infected/colonized with ESBL-KP. The index case was an 18-day-old infant born at 25 weeks' gestation who developed septicemia from ESBL-KP. Two other infants in the same room developed sepsis from ESBL-KP within 48 hours; both expired. Implementation of various infection prevention strategies resulted in prompt control of the outbreak within 3 weeks. The ESBL-KP isolates presented a single clone that was distinct from ESBL-KP identified previously in other units. Being housed in the same room as the index infant was the only risk factor identified by logistic regression analysis (P = .002).
Conclusion: This outbreak of ESBL-KP affected 11 infants and was associated with 2 deaths. Prompt control with eradication of the infecting strain from the NICU was achieved with multidisciplinary interventions based on standard infection prevention practices.
(C) 2013Elsevier, Inc.
