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Analysis of Three Outbreaks Due to Klebsiella Species in a Neonatal Intensive Care Unit

  • Melek Ayan (a1), Cigdem Kuzucu (a1), Riza Durmaz (a1), Elif Aktas (a1) and Zeynep Cizmeci (a1)...

Abstract

Objective:

To investigate the clinical, microbiological, and epidemiologic features of three outbreaks caused by Klebsiella during 3 years.

Setting:

Neonatal intensive care unit of a university hospital.

Patients:

Thirty affected neonates.

Methods:

Data were collected through chart reviews and conversations with physicians. Screening samples were obtained from the staff, the neonates, and the environment. Antibiogram typing and arbitrarily primed polymerase chain reaction-based fingerprinting were used to type the strains.

Results:

The first outbreak had 13 K. pneumoniae strains isolated. The second outbreak had 10 K. oxytoca strains isolated. The third outbreak had 20 K. pneumoniae strains isolated. More than half of the patients had low birth weights, were premature, and underwent mechanical ventilation and intravenous catheterization. Approximately three-fourths of the patients died. The isolates tested were completely susceptible to meropenem, cefoxitin, and ciprofloxacin and were resistant to cephalothin. More than half of these strains were resistant to many beta-lactam antibiotics, amikacin, and trimethoprim/sul-famethoxazole. Typing procedures yielded 3 antibiotypes and 3 genotypes among the isolates of the first outbreak, 3 antibiotypes with 1 subtype and 2 genotypes with 1 subtype in the second outbreak, and 2 antibiotypes and 2 genotypes in the third outbreak.

Conclusions:

Klebsiella outbreaks mainly affected premature neonates with intravenous catheters, mechanical ventilation, or both. The high mortality rate (76.7%) was notable. Resistance to multiple antibiotics, but mainly to broad-spectrum beta-lactam antibiotics, was observed, particularly in K. pneumoniae isolates. Molecular typing indicated that the three outbreaks were not related to one other (Infect Control Hosp Epidemiol 2003;24:495-500).

Copyright

Corresponding author

Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Inonu University, 44069 - Malatya, Turkey

References

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1.Podschun, R, Ullmann, U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev 1998;11:589603.
2.Patterson, JE, Hardin, TC, Kelly, CA, Garcia, RC, Jorgensen, JH. Association of antibiotic utilization measures and control of multiple-drug resistance in Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2000;2:455458.
3.Silva, J, Gatica, R, Aguilar, C, et al. Outbreak of infection with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a Mexican hospital. J Clin Microbiol 2001;39:31933196.
4.Sirot, J. Detection of extended-spectrum plasmid-mediated β-lactamases by disk diffusion. Clin Microbiol Infect 1996;2(suppl 1):3539.
5.Gniadkowski, M, Hryniewicz, W. Outbreak of ceftazidime-resistant Klebsiella pneumoniae in a pediatric hospital in Warsaw, Poland: clonal spread of the TEM-47 extended-spectrum β-lactamase (ESBL)-producing strain and transfer of a plasmid carrying the SHV-5-like ESBL-encoding gene. Antimicrob Agents Chemother 1998;42:30793085.
6.Siu, LK, Lu, P-L, Hsueh, P-R, et al. Bacteremia due to extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a pediatric oncology ward: clinical features and identification of different plasmids carrying both SHV-5 and TEM-1 genes. J Clin Microbiol 1999;37:40204027.
7.Peña, C, Pujol, M, Ardanuy, C, et al. Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended spectrum K-lactamases. Antimicrob Agents Chemother 1998;42:5358.
8.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.
9.Bingen, E. Applications of molecular methods to epidemiologic investigations of nosocomial infections in a pediatric hospital. Infect Control Hosp Epidemiol 1994;15:488493.
10.Tenover, FC, Arbeit, RD, Goering, RV. How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Molecular Typing Working Group of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 1997;18:426439.
11.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. Wayne, PA: National Committee for Clinical Laboratory Standards; 2001. Approved standard M2-A7.
12.Biendo, M, Laurans, G, Lefebvre, JF, Daoudi, F, Eb, F. Epidemiological study of an Acinetobacter baumannii outbreak by using a combination of antibiotyping and ribotyping. J Clin Microbiol 1999;37:21702175.
13.Jarlier, V, Nicolas, MH, Fournier, G, Philippon, A. Extended broad-spectrum β-lactamases conferring transferable resistance to newer β-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns. Rev Infect Dis 1988;10:867878.
14.Grundmann, HJ, Towner, KJ, Dijkshoorn, L, et al. Multicenter study using standardized protocols and reagents for evaluation of reproducibility of PCR-based fingerprinting of Acinetobacter spp. J Clin Microbiol 1997;35:30713077.
15.Tankovic, J, Legrand, R, Gatines, GD, Chmineau, V, Brun-Buisson, C, Davul, J. Characterization of a hospital outbreak of imipenem-resistant Acinetobacter baumannii by phenotyping and genotyping typing methods. J Clin Microbiol 1994;32:26772681.
16.Parasakthi, N, Vadivelu, J, Ariffin, H, Iyer, L, Palasubramaniam, S, Arasu, A. Epidemiology and molecular characterization of nosocomially transmitted multidrug-resistant Klebsiella pneumoniae. Int J Infect Dis 2000;4:123128.
17.Petros, AJ, O'Connell, M, Roberts, C, Wade, P, van Saene, HKF. Systemic antibiotics fail to clear multidrug-resistant Klebsiella from a pediatric ICU. Chest 2001;119:862866.
18.Reiss, I, Borkhardt, A, Füssle, R, Sziegoleit, A, Gortner, L. Disinfectant contaminated with Klebsiella oxytoca source of sepsis in babies. Lancet 2000;22:310.
19.French, GL, Shannon, KP, Simmons, N. Hospital outbreak of Klebsiella pneumoniae resistant to broad-spectrum cephalosporins and beta-lactam-beta-lactamase inhibitor combinations by hyperproduction of SHV-5 beta-lactamase. J Clin Microbiol 1996;34:358363.
20.Ariffin, H, Navaratnam, P, Mohamed, M, et al. Ceftazidime-resistant Klebsiella pneumoniae bloodstream infection in children with febrile neutropenia. Int J Infect Dis 2000;4:2125.
21.Livermore, DL. β lactamases in laboratory and clinical resistance. Clin Microbiol Rev 1995;8:557584.
22.Bush, K, Jacoby, GA, Medeiros, AA. A functional classification for 4-lactamases and its correlation with molecular structures. Antimicrob Agents Chemother 1993;39:12111233.
23.Durmaz, R, Durmaz, B, Koroglu, M, Tekerekoglu, MS. Detection and typing of extended-spectrum beta-lactamases in clinical isolates of the family Enterobacteriaceae in a medical center in Turkey. Microb Drug Resist 2001;7:171175.
24.Tunger, A, Hilmioglu, S, Dibek, MA, et al. Presence of extended spectrum beta lactamase in Klebsiella pneumoniae and Escherichia coli strains isolated as agents of nosocomial infection. Turkish Journal of Infections 1998;12:165168.
25.Evrensel, N, Koc, NA, Sumerkan, B. Detection of extended-spectrum β-lactamases in Gram-negative bacilli isolated from intensive-care units. J Infect Dis Clin Microbiol 1997;2:105108.
26.Komatsu, M, Ikeda, N, Aihara, M, et al. Hospital outbreak of MEN-1-derived extended spectrum beta-lactamase-producing Klebsiella pneumoniae. J Infect Chemother 2001;7:94101.
27.Eisen, D, Russell, EG, Tymms, M, Roper, EJ, Grayson, ML, Turnidge, J. Random amplified polymorphic DNA and plasmid analyses used in investigation of an outbreak of multiresistant Klebsiella pneumoniae. J Clin Microbiol 1995;33:713717.

Analysis of Three Outbreaks Due to Klebsiella Species in a Neonatal Intensive Care Unit

  • Melek Ayan (a1), Cigdem Kuzucu (a1), Riza Durmaz (a1), Elif Aktas (a1) and Zeynep Cizmeci (a1)...

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