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Nursery Epidemic Due to Multiply-Resistant Klebsiella pneumoniae: Epidemiologic Setting and Impact on Perinatal Health Care Delivery

Published online by Cambridge University Press:  02 January 2015

Kelly T. McKee Jr
Affiliation:
Departments of Pediatrics, Pathology, and Medicine, Vanderbilt University School of Medicine, the Vanderbilt University Children's Hospital, Nashville, Tennessee, and the Bureau of Laboratories, Centers for Disease Control, Atlanta, Georgia
Robert B. Cotton
Affiliation:
Departments of Pediatrics, Pathology, and Medicine, Vanderbilt University School of Medicine, the Vanderbilt University Children's Hospital, Nashville, Tennessee, and the Bureau of Laboratories, Centers for Disease Control, Atlanta, Georgia
Charles W. Stratton
Affiliation:
Departments of Pediatrics, Pathology, and Medicine, Vanderbilt University School of Medicine, the Vanderbilt University Children's Hospital, Nashville, Tennessee, and the Bureau of Laboratories, Centers for Disease Control, Atlanta, Georgia
Gail B. Lavely
Affiliation:
Departments of Pediatrics, Pathology, and Medicine, Vanderbilt University School of Medicine, the Vanderbilt University Children's Hospital, Nashville, Tennessee, and the Bureau of Laboratories, Centers for Disease Control, Atlanta, Georgia
Peter F. Wright
Affiliation:
Departments of Pediatrics, Pathology, and Medicine, Vanderbilt University School of Medicine, the Vanderbilt University Children's Hospital, Nashville, Tennessee, and the Bureau of Laboratories, Centers for Disease Control, Atlanta, Georgia
Jayant P. Shenai
Affiliation:
Departments of Pediatrics, Pathology, and Medicine, Vanderbilt University School of Medicine, the Vanderbilt University Children's Hospital, Nashville, Tennessee, and the Bureau of Laboratories, Centers for Disease Control, Atlanta, Georgia
Martin E. Evans
Affiliation:
Departments of Pediatrics, Pathology, and Medicine, Vanderbilt University School of Medicine, the Vanderbilt University Children's Hospital, Nashville, Tennessee, and the Bureau of Laboratories, Centers for Disease Control, Atlanta, Georgia
M. Ann Melly
Affiliation:
Departments of Pediatrics, Pathology, and Medicine, Vanderbilt University School of Medicine, the Vanderbilt University Children's Hospital, Nashville, Tennessee, and the Bureau of Laboratories, Centers for Disease Control, Atlanta, Georgia
J.J. Farmer
Affiliation:
Departments of Pediatrics, Pathology, and Medicine, Vanderbilt University School of Medicine, the Vanderbilt University Children's Hospital, Nashville, Tennessee, and the Bureau of Laboratories, Centers for Disease Control, Atlanta, Georgia
David T. Karzon
Affiliation:
Departments of Pediatrics, Pathology, and Medicine, Vanderbilt University School of Medicine, the Vanderbilt University Children's Hospital, Nashville, Tennessee, and the Bureau of Laboratories, Centers for Disease Control, Atlanta, Georgia
William Schaffner
Affiliation:
Departments of Pediatrics, Pathology, and Medicine, Vanderbilt University School of Medicine, the Vanderbilt University Children's Hospital, Nashville, Tennessee, and the Bureau of Laboratories, Centers for Disease Control, Atlanta, Georgia

Abstract

Gram-negative bacilli frequently cause epidemics in high-risk newborn intensive care units. Recently, an epidemic caused by a multiply-resistant K. pneumoniae, serotype 21, occurred in the Vanderbilt University intensive care nursery. The background of this outbreak included an increasing endemic nosocomial sepsis rate, operation of the facility in excess of rated capacity, and increasingly inadequate nurse-to-patient staffing ratios. The epidemic lasted 11 weeks; 26 (12%) of the 232 infants at risk in the unit became colonized. Five infants developed systemic illness and one died. Cohorting, reinforcement of strict handwashing and isolation procedures, and closure of the unit to outborn admissions resulted in rapid termination of the outbreak. Followup studies performed on infants colonized with the epidemic bacterium demonstrated persistent fecal shedding up to 13 months following discharge from the hospital. This epidemic had a detrimental influence on high-risk newborn and obstetric health care delivery in an area encompassing portions of three states. Under a system of progressively more sophisticated referral units, nosocomial infections occurring at a tertiary center can have an impact on other hospitals within the network.

Type
Original-Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1982

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