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Outbreak of Extended-Spectrum Beta-Lactamase–Producing Klebsiella Pneumoniae in a Neonatal Intensive Care Unit Linked to Artificial Nails

Published online by Cambridge University Press:  02 January 2015

Archana Gupta
Affiliation:
Department of Pediatrics, Columbia University, New York-Presbyterian Hospital, New York, New York
Phyllis Della-Latta
Affiliation:
Department of Pathology, Columbia University, New York-Presbyterian Hospital, New York, New York
Betsy Todd
Affiliation:
Department of Epidemiology, Columbia University, New York-Presbyterian Hospital, New York, New York
Pablo San Gabriel
Affiliation:
Department of Pediatrics, Columbia University, New York-Presbyterian Hospital, New York, New York
Janet Haas
Affiliation:
School of Nursing, Columbia University, New York-Presbyterian Hospital, New York, New York
Fann Wu
Affiliation:
Department of Pathology, Columbia University, New York-Presbyterian Hospital, New York, New York
David Rubenstein
Affiliation:
Department of Pediatrics, Columbia University, New York-Presbyterian Hospital, New York, New York
Lisa Saiman
Affiliation:
Department of Pediatrics, Columbia University, New York-Presbyterian Hospital, New York, New York Department of Epidemiology, Columbia University, New York-Presbyterian Hospital, New York, New York

Abstract

Background:

From April to June 2001, an outbreak of extended-spectrum beta-lactamase (ESBL)–producing Klebsiella pneumoniae infections was investigated in our neonatal intensive care unit.

Methods:

Cultures of the gastrointestinal tracts of patients, the hands of healthcare workers (HCWs), and the environment were performed to detect potential reservoirs for ESBL-producing K. pneumoniae. Strains of K. pneumoniae were typed by pulsed-field gel electrophoresis using Xbal. A case–control study was performed to determine risk factors for acquisition of the outbreak clone (clone A); cases were infants infected or colonized with clone A and controls (3 per case) were infants with negative surveillance cultures.

Results:

During the study period, 19 case-infants, of whom 13 were detected by surveillance cultures, harbored clone A. The overall attack rate for the outbreak strain was 45%; 9 of 19 infants presented with invasive disease (n = 6) or developed invasive disease (n = 3) after colonization was detected. Clone A was found on the hands of 2 HCWs, 1 of whom wore artificial nails, and on the designated stethoscope of a case-infant. Multiple logistic regression analysis revealed that length of stay per day (odds ratio [OR], 1.05; 95% confidence interval [CI95], 1.02 to 1.09) and exposure to the HCW wearing artificial fingernails (OR, 7.87; CI95, 1.75 to 35.36) were associated with infection or colonization with clone A.

Conclusion:

Short, well-groomed, natural nails should be mandatory for HCWs with direct patient contact.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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Outbreak of Extended-Spectrum Beta-Lactamase–Producing Klebsiella Pneumoniae in a Neonatal Intensive Care Unit Linked to Artificial Nails
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