Prompt Control of an Outbreak Caused by Extended-Spectrum β-Lactamase–Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit

• Published in: The Journal of pediatrics 2013-09, Vol.163 (3), p.672-679.e3
• Main Authors: Cantey, Joseph B., MD, Sreeramoju, Pranavi, MD, Jaleel, Mambarambath, MD, Treviño, Sylvia, MT, Gander, Rita, PhD, Hynan, Linda S., PhD, Hill, Jennifer, BSN, Brown, Cari, BSN, Chung, Wendy, MD, MPH, Siegel, Jane D., MD, Sánchez, Pablo J., MD
• Format: Article
• Language: English
• Subjects: beta-Lactam Resistance; beta-Lactamases - metabolism; Biomarkers - metabolism; Cohort Studies; Cross Infection - epidemiology; Cross Infection - etiology; Cross Infection - prevention & control; Cross Infection - transmission; Disease Outbreaks; Female; Humans; Infant, Newborn; Infection Control - methods; Infection Control - organization & administration; Intensive Care Units, Neonatal; Klebsiella Infections - epidemiology; Klebsiella Infections - etiology; Klebsiella Infections - prevention & control; Klebsiella Infections - transmission; Klebsiella pneumoniae - isolation & purification; Klebsiella pneumoniae - metabolism; Logistic Models; Male; Patient Care Team; Pediatrics; Risk Factors; Texas
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2013.03.001

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.