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Prompt control of an outbreak caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit.
J Pediatr. 2013 Sep; 163(3):672-9.e1-3.JPed

Abstract

OBJECTIVES

To assess the effectiveness of a set of multidisciplinary interventions aimed at limiting patient-to-patient transmission of extended-spectrum β-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.

Authors+Show Affiliations

Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, USA. Pablo.Sanchez@utsouthwestern.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

23582136

Citation

Cantey, Joseph B., et al. "Prompt Control of an Outbreak Caused By Extended-spectrum Β-lactamase-producing Klebsiella Pneumoniae in a Neonatal Intensive Care Unit." The Journal of Pediatrics, vol. 163, no. 3, 2013, pp. 672-9.e1-3.
Cantey JB, Sreeramoju P, Jaleel M, et al. Prompt control of an outbreak caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit. J Pediatr. 2013;163(3):672-9.e1-3.
Cantey, J. B., Sreeramoju, P., Jaleel, M., Treviño, S., Gander, R., Hynan, L. S., Hill, J., Brown, C., Chung, W., Siegel, J. D., & Sánchez, P. J. (2013). Prompt control of an outbreak caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit. The Journal of Pediatrics, 163(3), 672-e1-3. https://doi.org/10.1016/j.jpeds.2013.03.001
Cantey JB, et al. Prompt Control of an Outbreak Caused By Extended-spectrum Β-lactamase-producing Klebsiella Pneumoniae in a Neonatal Intensive Care Unit. J Pediatr. 2013;163(3):672-9.e1-3. PubMed PMID: 23582136.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prompt control of an outbreak caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit. AU - Cantey,Joseph B, AU - Sreeramoju,Pranavi, AU - Jaleel,Mambarambath, AU - Treviño,Sylvia, AU - Gander,Rita, AU - Hynan,Linda S, AU - Hill,Jennifer, AU - Brown,Cari, AU - Chung,Wendy, AU - Siegel,Jane D, AU - Sánchez,Pablo J, Y1 - 2013/04/10/ PY - 2012/08/01/received PY - 2013/01/25/revised PY - 2013/03/01/accepted PY - 2013/4/16/entrez PY - 2013/4/16/pubmed PY - 2013/11/19/medline KW - ESBL KW - Extended-spectrum β-lactamase KW - HCP KW - Health care personnel KW - KP KW - Klebsiella pneumoniae KW - MDROs KW - Multidrug-resistant organisms KW - NICU KW - Neonatal intensive care unit KW - PMH KW - Parkland Memorial Hospital SP - 672-9.e1-3 JF - The Journal of pediatrics JO - J. Pediatr. VL - 163 IS - 3 N2 - OBJECTIVES: To assess the effectiveness of a set of multidisciplinary interventions aimed at limiting patient-to-patient transmission of extended-spectrum β-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. SN - 1097-6833 UR - https://www.unboundmedicine.com/medline/citation/23582136/Prompt_control_of_an_outbreak_caused_by_extended_spectrum_β_lactamase_producing_Klebsiella_pneumoniae_in_a_neonatal_intensive_care_unit_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3476(13)00266-7 DB - PRIME DP - Unbound Medicine ER -