Abstract
Background: The epidemiological–microbiological characteristics and effective intervention measures in an outbreak due to extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae in a neonatal intensive care unit are described. Materials and methods: Cases from June 22, 2018 to February 11, 2019 were analyzed. Microbiological analysis of intestinal carriage of ESBL-producing K. pneumoniae and environmental samples was conducted. Strain relationships were studied by pulsed-field gel electrophoresis (PFGE). Results: A 35-week outbreak affecting 41 patients, with eight infected, 33 colonized, and two deceased patients occurred. Two stages of the outbreak were observed with differences in the frequency of intestinal carriage of ESBL-producing K. pneumoniae. The same genetic subtype was seen in patient strains and was different from strains isolated from the environment. Deficiencies in contact precautions, hand hygiene, and handling of breast milk were observed. Conclusions: A monoclonal outbreak by ESBL-producing K. pneumoniae that occurred in two phases and the different control measures in each of the stages is described. Effective control measures are mainly based on improving compliance with standard precautions and contact precautions, and other complementary measures are described such as proper handling of breast milk, periodic carriage studies, and the generation of three patient cohorts.
Highlights
The epidemiological–microbiological characteristics and effective intervention measures in an outbreak due to extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae in a neonatal intensive care unit are described
In the pre-epidemic period from January 2017 to June 21, 2018, no ESBL-producing strains of K. pneumoniae were isolated in neonatal critical patient unit (CPU) patients
ESBLproducing K. pneumoniae was isolated in 41 (13.4%) from either a clinical sample taken for diagnostic purposes or inguinal-rectal swab as part of active surveillance; eight cases (2.6%) corresponded to infected patients and 33 (10.8%) to patients who were only colonized with this agent
Summary
The epidemiological–microbiological characteristics and effective intervention measures in an outbreak due to extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae in a neonatal intensive care unit are described. Microbiological analysis of intestinal carriage of ESBL-producing K. pneumoniae and environmental samples was conducted. Two stages of the outbreak were observed with differences in the frequency of intestinal carriage of ESBL-producing K. pneumoniae. Deficiencies in contact precautions, hand hygiene, and handling of breast milk were observed. Conclusions: A monoclonal outbreak by ESBL-producing K. pneumoniae that occurred in two phases and the different control measures in each of the stages is described. Effective control measures are mainly based on improving compliance with standard precautions and contact precautions, and other complementary measures are described such as proper handling of breast milk, periodic carriage studies, and the generation of three patient cohorts
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