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Liébana-Rodríguez M, Recacha-Villamor E, Díaz-Molina C, Pérez-Palacios P, Martín-Hita L, Enríquez-Maroto F, Gutiérrez-Fernández J. Outbreaks by Klebsiella oxytoca in neonatal intensive care units: Analysis of an outbreak in a tertiary hospital and systematic review. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:294-301. [PMID: 37328344 DOI: 10.1016/j.eimce.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/10/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Klebsiella oxytoca can cause nosocomial infections, affecting vulnerable newborns. There are few studies describing nosocomial outbreaks in the neonatal intensive care units (NICU). In this study, a systematic review of the literature was carried out to know the main characteristics of these outbreaks and the evolution of one is described. METHODS We conducted a systematic review in the Medline database up to July 2022, and present a descriptive study of an outbreak with 21 episodes in the NICU of a tertiary hospital, between September 2021 and January 2022. RESULTS 9 articles met the inclusion criteria. The duration of outbreaks was found to be variable, of which 4 (44.4%) lasted for a year or more. Colonization (69%) was more frequent than infections (31%) and the mortality rate was 22.4%. In studies describing sources, the most frequent was the environmental origin (57.1%). In our outbreak there were 15 colonizations and 6 infections. The infections were mild conjunctivitis without sequelae. Molecular typing analysis made it possible to detect 4 different clusters. CONCLUSIONS There is an important variability in the evolution and results of the published outbreaks, highlighting a greater number of colonized, use of PFGE (pulsed-field gel electrophoresis) techniques for molecular typing and implementation of control measures. Finally, we describe an outbreak in which 21 neonates were affected with mild infections, resolved without sequelae and whose control measures were effective.
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Affiliation(s)
- María Liébana-Rodríguez
- Departamento de Medicina Preventiva y Salud Pública, Hospital Virgen de las Nieves. Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain
| | - Esther Recacha-Villamor
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Carmen Díaz-Molina
- Departamento de Medicina Preventiva y Salud Pública, Hospital Virgen de las Nieves. Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain
| | - Patricia Pérez-Palacios
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Lina Martín-Hita
- Departamento de Microbiología. Hospital Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain
| | - Francisca Enríquez-Maroto
- Departamento de Medicina Preventiva y Salud Pública, Hospital Virgen de las Nieves. Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain
| | - José Gutiérrez-Fernández
- Departamento de Microbiología. Hospital Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain; Departamento de Microbiología, Universidad de Granada-Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain.
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Song WS, Park HW, Oh MY, Jo JY, Kim CY, Lee JJ, Jung E, Lee BS, Kim KS, Kim EAR. Neonatal sepsis-causing bacterial pathogens and outcome of trends of their antimicrobial susceptibility a 20-year period at a neonatal intensive care unit. Clin Exp Pediatr 2022; 65:350-357. [PMID: 34886592 PMCID: PMC9263424 DOI: 10.3345/cep.2021.00668] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Due to increases in the number of infants born with younger gestational age (GA) and lower birth weight, the incidence of neonatal sepsis is increasing. PURPOSE We investigated the changes in the prevalence of bacterial pathogens, their antimicrobial susceptibility, and sepsis-related mortality during 20 years at a neonatal intensive care unit. METHODS The study period was divided into two 10-year phases (1998-2007 vs. 2008-2017). Medical records were reviewed to gather data on demographics, causative microbial pathogens, incidence of multidrug-resistant organisms, antimicrobial susceptibility, and rates of sepsis-related mortality. RESULTS In both study phases, the most common pathogens for neonatal sepsis were coagulase-negative Staphylococcus (CoNS) (28.6%) and Enterobacter cloacae (16.1%) for early-onset sepsis (EOS, ≤72 hours after birth) and CoNS (54.7%) and Staphylococcus aureus (12.9%) for late-onset sepsis (LOS, >72 hours after birth). CoNS and S. aureus showed 100% sensitivity to vancomycin in both phases. The susceptibility of S. aureus to oxacillin increased from 19.2% to 57.9% in phase II than phase I. K. pneumonia and E. cloacae showed increases in its susceptibility to gentamicin, cefotaxime and ceftriaxone in phase II than phase I. In both phases, the most common pathogens that caused sepsis-related death were K. pneumoniae (18.2%) and Pseudomonas aeruginosa (13.6%). Sepsis-related mortality rate was higher in infants with GA <37 weeks than those with GA over 37 weeks (P=0.016). In addition, the mortality rate of neonatal sepsis caused by gram-negative bacteria was significantly higher than that caused by gram-positive bacteria (P<0.001). CONCLUSIONS CoNS was the most common pathogen for EOS and LOS. While we found significant changes in antimicrobial sensitivities over time. GA below 37 weeks and gram-negative organisms are associated with mortality rate.
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Affiliation(s)
- Woo Sun Song
- Department of Medicine, Kyungpook National University, College of Medicine, Daegu, Korea
| | - Hye Won Park
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
| | - Moon Youn Oh
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Young Jo
- Department of Pediatrics, Gyeongsang National University Hospital, Jinju, Korea
| | - Chae Young Kim
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | | | - Euiseok Jung
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Sop Lee
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Soo Kim
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ellen Ai-Rhan Kim
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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Karabay M, Kaya G, Hafizoglu T, Karabay O. Effect of camera monitoring and feedback along with training on hospital infection rate in a neonatal intensive care unit. Ann Clin Microbiol Antimicrob 2019; 18:35. [PMID: 31722715 PMCID: PMC6852772 DOI: 10.1186/s12941-019-0332-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In terms of pediatric healthcare-associated infections (HAI), neonatal intensive care units (NICU) constitute the greatest risk. Contacting a health care personnel, either directly or indirectly, elevates NICU occurrence rate and risks other infants in the same unit. In this study, it is aimed to retrospectively analyze the effect of the training along with camera monitoring and feedback (CMAF) to control the infection following a small outbreak. METHODS ESBL producing Klebsiella pneumoniae was detected on three infants in May 2014 at the isolation room of Sakarya University Hospital NICU. Precautions were taken to prevent further spread of the infection. The infected infants were isolated and the decolonization process was initiated. For this aspect, health care workers (HCWs) in NICU were trained for infection control measures. An infection control committee has monitored the HCWs. Before monitoring, an approval was obtained from the hospital management and HCWs were informed about the CMAF, who were then periodically updated. On a weekly basis, NICU workers were provided with the feedbacks. Epidemic period and post-epidemic control period (June-July-August 2014) were evaluated and p value < 0.05 was considered statistically significant. RESULTS Healthcare-associated infection (HAI) density was 9.59% before the onset of the CMAF, whereas it was detected as 2.24% during the CMAF period (p < 0.05). Following the precautions, HAI and HAI density rates have reduced to 76.6% and 74.85%, respectively. Moreover, hand hygiene compliance of health care workers was found 49.0% before the outbreak, whereas this rate has elevated to 62.7% after CMAF. CONCLUSIONS Healthcare workers should be monitored in order to increase their compliance for infection control measures. Here, we emphasized that that CMAF of health workers may contribute reducing the HAI rate in the NICU.
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Affiliation(s)
- Meltem Karabay
- Department of Pediatrics, Newborn Unit, Sakarya University Faculty of Medicine, Sakarya, 54100, Türkiye.
| | - Gulsum Kaya
- Member of Infection Control Committee, Sakarya University Faculty of Medicine, Adnan Menderes Bulvari, Sakarya, Turkey
| | - Taner Hafizoglu
- Department of Pediatrics, Newborn Unit, Sakarya University Faculty of Medicine, Sakarya, 54100, Türkiye
| | - Oguz Karabay
- Member of Infection Control Committee, Sakarya University Faculty of Medicine, Adnan Menderes Bulvari, Sakarya, Turkey
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Justo-da-Silva LH, De-Azeredo AN, Bueno AC, Montezzi LF, Leobons MBGP, Alves MS, de Souza Inhaquite P, Santos RR, Girão VBC, da Cunha AJLA, Pessoa-Silva CL, Picão RC, Hofer CB, Santoro-Lopes G, Riley LW, Moreira BM. Diversity of clonal types of Klebsiella pneumoniae causing infections in intensive care neonatal patients in a large urban setting. Braz J Microbiol 2019; 50:935-942. [PMID: 31401781 DOI: 10.1007/s42770-019-00128-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 07/24/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Klebsiella infections are reported from neonatal intensive care units (NICUs) worldwide, but data on their incidence and genetic diversity remain scarce. OBJECTIVE We determined the incidence and genetic diversity of Klebsiella infections in NICU patients in Rio de Janeiro. METHODS This was a prospective study including newborns admitted to NICU in three hospitals during April 2005-November 2006 and March 2008-February 2009. Klebsiella pneumoniae isolates were genotyped by multilocus sequence typing (MLST) and extended spectrum β-lactamases (ESBL) were characterized. RESULTS Klebsiella infections occurred in 38 of 3984 patients (incidence rate, 9.5/1000 admissions); 14 (37%) of these 38 newborns died. Two clonal groups, CC45 and CC1041, caused 11 cases (42% of K. pneumoniae infection). Ten (32%) of the isolates causing infection produced ESBL, 9 of which (83%) carried blaCTX-M-15, all belonging to clonal complex (CC) 45 and CC1041. Nine of these ESBL-producing isolates were confined to only one of the NICUs. MAJOR CONCLUSIONS The high incidence of Klebsiella infections in NICU in Rio de Janeiro appeared to be due to a combination of frequent sporadic infections caused by multiple K. pneumoniae genotypes and small outbreaks caused by dominant multidrug-resistant clones.
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Affiliation(s)
- Livia Helena Justo-da-Silva
- Instituto de Microbiologia, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Lab I2-59, 21941-902, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | - Andrea Nunes De-Azeredo
- Faculdade de Medicina, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Lab I2-59, 21941-902, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | | | - Lara Feital Montezzi
- Instituto de Microbiologia, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Lab I2-59, 21941-902, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Valéria Brígido Carvalho Girão
- Instituto de Microbiologia, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Lab I2-59, 21941-902, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | - Antônio José Ledo Alves da Cunha
- Faculdade de Medicina, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Lab I2-59, 21941-902, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | - Carmem Lucia Pessoa-Silva
- Faculdade de Medicina, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Lab I2-59, 21941-902, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | - Renata Cristina Picão
- Instituto de Microbiologia, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Lab I2-59, 21941-902, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | - Cristina Barroso Hofer
- Faculdade de Medicina, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Lab I2-59, 21941-902, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | - Guilherme Santoro-Lopes
- Faculdade de Medicina, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Lab I2-59, 21941-902, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | | | - Beatriz Meurer Moreira
- Instituto de Microbiologia, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Lab I2-59, 21941-902, Cidade Universitária, Rio de Janeiro, RJ, Brazil.
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Delerue T, de Pontual L, Carbonnelle E, Zahar JR. The potential role of microbiota for controlling the spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in neonatal population. F1000Res 2017; 6:1217. [PMID: 28781766 PMCID: PMC5531162 DOI: 10.12688/f1000research.10713.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 12/15/2022] Open
Abstract
The spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in the hospital and also the community is worrisome. Neonates particularly are exposed to the risk of ESBL-PE acquisition and, owing to the immaturity of their immune system, to a higher secondary risk of ESBL-PE-related infection. Reducing the risk of acquisition in the hospital is usually based on a bundle of measures, including screening policies at admission, improving hand hygiene compliance, and decreasing antibiotic consumption. However, recent scientific data suggest new prevention opportunities based on microbiota modifications.
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Affiliation(s)
- Thibaud Delerue
- Département de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 9300 Bobigny, France
| | - Loic de Pontual
- Service de pédiatrie, hôpital Jean-Verdier, Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13, AP-HP, 93140 Bondy, France
| | - Etienne Carbonnelle
- Département de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 9300 Bobigny, France
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France
| | - Jean-Ralph Zahar
- Département de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 9300 Bobigny, France
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France
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Powell EA, Haslam D, Mortensen JE. Performance of the check-points check-MDR CT103XL assay utilizing the CDC/FDA antimicrobial resistance isolate bank. Diagn Microbiol Infect Dis 2017; 88:219-221. [DOI: 10.1016/j.diagmicrobio.2017.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/17/2017] [Accepted: 04/24/2017] [Indexed: 01/19/2023]
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Roode G, Bütow KW, Naidoo S. Preoperative evaluation of micro-organisms in non-operated cleft in soft palate: impact on use of antibiotics. Br J Oral Maxillofac Surg 2017; 55:127-131. [DOI: 10.1016/j.bjoms.2016.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/20/2016] [Indexed: 11/27/2022]
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Birt J, Le Doare K, Kortsalioudaki C, Lawn J, Heath PT, Sharland M. Lack of evidence for the efficacy of enhanced surveillance compared to other specific interventions to control neonatal healthcare-associated infection outbreaks. Trans R Soc Trop Med Hyg 2016; 110:98-106. [PMID: 26822602 PMCID: PMC4731007 DOI: 10.1093/trstmh/trv116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Despite current prevention efforts, outbreaks of healthcare-associated infections in neonatal units remain high globally, with a considerable burden of mortality and morbidity. Methods We searched Medline, Cochrane Library and Outbreak database to identify studies of neonatal healthcare-associated outbreaks between 2005 and 2015 that described interventions to control outbreaks. All studies were evaluated using the ORION guidance. Results Thirty studies were identified including 17 102 infants of whom 664 (3.9%) became infected. No single intervention was identified that reduced duration or mortality. Studies that introduced multiple interventions had significantly reduced case fatality ratio and outbreak duration compared to those that used basic surveillance only. Low and low-middle income countries reported the fewest interventions to control outbreaks and these studies were also associated with higher mortality than that found in middle and high income countries. Conclusions Systematic reporting and formal evaluation of interventions used to reduce healthcare-associated neonatal infection outbreaks is key to identifying containment strategies worldwide.
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Affiliation(s)
- J Birt
- Public Health England, Manor Farm Road, Porton Down SP4 0JG, UK Manchester University, Oxford Rd, Manchester M13 9PL, UK
| | - K Le Doare
- Public Health England, Manor Farm Road, Porton Down SP4 0JG, UK St George's University of London, Blackshaw Road, London SW17 0TE, UK Centre for International Child Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - C Kortsalioudaki
- St George's University of London, Blackshaw Road, London SW17 0TE, UK
| | - J Lawn
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - P T Heath
- St George's University of London, Blackshaw Road, London SW17 0TE, UK
| | - M Sharland
- St George's University of London, Blackshaw Road, London SW17 0TE, UK
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Stapleton PJM, Murphy M, McCallion N, Brennan M, Cunney R, Drew RJ. Outbreaks of extended spectrum beta-lactamase-producing Enterobacteriaceae in neonatal intensive care units: a systematic review. Arch Dis Child Fetal Neonatal Ed 2016; 101:F72-8. [PMID: 26369370 DOI: 10.1136/archdischild-2015-308707] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/27/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To establish the number of outbreaks of extended spectrum beta-lactamase (ESBL) producing organisms in neonatal intensive care units (NICUs), to determine causes, mortality rates, proportions of infants colonised and infected and the interventions that terminated outbreaks. METHODS A systematic review of the literature in English, Spanish and French was undertaken with searches in four databases. The review conformed to the PRISMA guidelines, and the data extraction was modelled on the ORION criteria for studies of nosocomial infection. RESULTS 75 studies fulfilled the inclusion criteria. There were 1185 cases of colonisation, 860 infections and 139 deaths. The median outbreak duration was 6.2 months (IQR 2.0-7.5 months). Klebsiella pneumoniae was the most frequently implicated pathogen. Understaffing was the most frequent risk factor for outbreaks. The most commonly identified source was admission of an ESBL-colonised infant with subsequent horizontal dissemination. The main interventions described were improved infection-control procedures and screening of staff and the environment. 26 studies were included in the quantitative analysis. Random effects meta-analysis indicated high mortality rates in infants who developed infection (31%, 95% CI 20% to 43%). CONCLUSION ESBL outbreaks in NICUs are associated with significant mortality and prolonged disruption. Understaffing is a major risk factor, but is infrequently addressed by interventions. Poor infection-control procedures are frequently implicated as contributing to ESBL spread. Better reporting of outbreaks may help clarify the role for routine ESBL screening in NICUs.
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Affiliation(s)
- Patrick J M Stapleton
- Department of Microbiology, Temple Street Children's University Hospital, Dublin, Ireland
| | | | - Naomi McCallion
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland Department of Paediatrics, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Marion Brennan
- Department of Midwifery, Rotunda Hospital, Dublin, Ireland
| | - Robert Cunney
- Department of Microbiology, Temple Street Children's University Hospital, Dublin, Ireland HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - Richard J Drew
- Department of Microbiology, Rotunda Hospital, Dublin, Ireland Department of Microbiology, Royal College of Surgeons of Ireland, Dublin, Ireland
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10
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Denkel LA, Gastmeier P, Piening B. To screen or not to screen mothers of preterm infants for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). J Perinatol 2015; 35:893-4. [PMID: 26507145 DOI: 10.1038/jp.2015.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- L A Denkel
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - B Piening
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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11
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Hendrik TC, Voor in ‘t holt AF, Vos MC. Clinical and Molecular Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Klebsiella spp.: A Systematic Review and Meta-Analyses. PLoS One 2015; 10:e0140754. [PMID: 26485570 PMCID: PMC4617432 DOI: 10.1371/journal.pone.0140754] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/30/2015] [Indexed: 12/30/2022] Open
Abstract
Healthcare-related infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella spp. are of major concern. To control transmission, deep understanding of the transmission mechanisms is needed. This systematic review aimed to identify risk factors and sources, clonal relatedness using molecular techniques, and the most effective control strategies for ESBL-producing Klebsiella spp. A systematic search of PubMed, Embase, and Outbreak Database was performed. We identified 2771 articles from November 25th, 1960 until April 7th, 2014 of which 148 were included in the systematic review and 23 in a random-effects meta-analysis study. The random-effects meta-analyses showed that underlying disease or condition (odds ratio [OR] = 6.25; 95% confidence interval [CI] = 2.85 to 13.66) generated the highest pooled estimate. ESBL-producing Klebsiella spp. were spread through person-to-person contact and via sources in the environment; we identified both monoclonal and polyclonal presence. Multi-faceted interventions are needed to prevent transmission of ESBL-producing Klebsiella spp.
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Affiliation(s)
- Tirza C. Hendrik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne F. Voor in ‘t holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Margreet C. Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- * E-mail:
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12
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Sudarwanto M, Akineden Ö, Odenthal S, Gross M, Usleber E. Extended-Spectrum β-Lactamase (ESBL)-Producing Klebsiella pneumoniae in Bulk Tank Milk from Dairy Farms in Indonesia. Foodborne Pathog Dis 2015; 12:585-90. [PMID: 26135892 DOI: 10.1089/fpd.2014.1895] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Bulk tank milk from 80 dairy farms located in the West Java Region of Indonesia was analyzed for the presence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Isolates from seven dairy farms were ESBL positive, and all were identified as Klebsiella pneumoniae. The isolates showed ESBL-characteristic antibiotic resistance patterns. Further analysis revealed that all K. pneumoniae isolates harbored the blaSHV gene, and two isolates were additionally positive for the blaTEM-1 and blaCTX-M-15 genes. Isolates from different farms were clonally diverse according to macrorestriction analysis. The results indicate that the relatively high frequency of ESBL-producing K. pneumoniae in bulk tank milk implies the risk that milk is both a source of local exposure and a vector contributing to the supraregional spread of antibiotic-resistant bacteria by trade.
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Affiliation(s)
- Mirnawati Sudarwanto
- 1 Laboratory of Veterinary Public Health, Faculty of Veterinary Medicine, Bogor Agricultural University , Bogor, West Java, Indonesia
| | - Ömer Akineden
- 2 Dairy Sciences, Institute of Veterinary Food Science , Justus-Liebig University Giessen, Giessen, Germany
| | - Sabrina Odenthal
- 2 Dairy Sciences, Institute of Veterinary Food Science , Justus-Liebig University Giessen, Giessen, Germany
| | - Madeleine Gross
- 2 Dairy Sciences, Institute of Veterinary Food Science , Justus-Liebig University Giessen, Giessen, Germany
| | - Ewald Usleber
- 2 Dairy Sciences, Institute of Veterinary Food Science , Justus-Liebig University Giessen, Giessen, Germany
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Haller S, Eller C, Hermes J, Kaase M, Steglich M, Radonić A, Dabrowski PW, Nitsche A, Pfeifer Y, Werner G, Wunderle W, Velasco E, Abu Sin M, Eckmanns T, Nübel U. What caused the outbreak of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit, Germany 2009 to 2012? Reconstructing transmission with epidemiological analysis and whole-genome sequencing. BMJ Open 2015; 5:e007397. [PMID: 25967999 PMCID: PMC4431171 DOI: 10.1136/bmjopen-2014-007397] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE We aimed to retrospectively reconstruct the timing of transmission events and pathways in order to understand why extensive preventive measures and investigations were not sufficient to prevent new cases. METHODS We extracted available information from patient charts to describe cases and to compare them to the normal population of the ward. We conducted a cohort study to identify risk factors for pathogen acquisition. We sequenced the available isolates to determine the phylogenetic relatedness of Klebsiella pneumoniae isolates on the basis of their genome sequences. RESULTS The investigation comprises 37 cases and the 10 cases with ESBL (extended-spectrum beta-lactamase)-producing K. pneumoniae bloodstream infection. Descriptive epidemiology indicated that a continuous transmission from person to person was most likely. Results from the cohort study showed that 'frequent manipulation' (a proxy for increased exposure to medical procedures) was significantly associated with being a case (RR 1.44, 95% CI 1.02 to 2.19). Genome sequences revealed that all 48 bacterial isolates available for sequencing from 31 cases were closely related (maximum genetic distance, 12 single nucleotide polymorphisms). Based on our calculation of evolutionary rate and sequence diversity, we estimate that the outbreak strain was endemic since 2008. CONCLUSIONS Epidemiological and phylogenetic analyses consistently indicated that there were additional, undiscovered cases prior to the onset of microbiological screening and that the spread of the pathogen remained undetected over several years, driven predominantly by person-to-person transmission. Whole-genome sequencing provided valuable information on the onset, course and size of the outbreak, and on possible ways of transmission.
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Affiliation(s)
- Sebastian Haller
- Postgraduate Training for Applied Epidemiology, Berlin, Germany, affiliated to the European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
- Division of Healthcare-Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Christoph Eller
- Division of Nosocomial Pathogens and Antibiotic Resistances, Department for Infectious Diseases, Robert Koch Institute, Wernigerode, Germany
- Department of Laboratory Medicine, University Hospital Halle, Halle, Germany
| | - Julia Hermes
- Division of Healthcare-Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Martin Kaase
- Department of Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
| | - Matthias Steglich
- Division of Nosocomial Pathogens and Antibiotic Resistances, Department for Infectious Diseases, Robert Koch Institute, Wernigerode, Germany
| | - Aleksandar Radonić
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses, Robert Koch Institute, Berlin, Germany
| | - Piotr Wojtek Dabrowski
- Central Administration Department, Information Technology, Robert Koch Institute, Berlin, Germany
| | - Andreas Nitsche
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses, Robert Koch Institute, Berlin, Germany
| | - Yvonne Pfeifer
- Division of Nosocomial Pathogens and Antibiotic Resistances, Department for Infectious Diseases, Robert Koch Institute, Wernigerode, Germany
| | - Guido Werner
- Division of Nosocomial Pathogens and Antibiotic Resistances, Department for Infectious Diseases, Robert Koch Institute, Wernigerode, Germany
| | - Werner Wunderle
- Department of Public Health, Gesundheitsamt Bremen (Local Public Health Service), Bremen, Germany
| | - Edward Velasco
- Division of Healthcare-Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Muna Abu Sin
- Division of Healthcare-Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Tim Eckmanns
- Division of Healthcare-Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Ulrich Nübel
- Division of Nosocomial Pathogens and Antibiotic Resistances, Department for Infectious Diseases, Robert Koch Institute, Wernigerode, Germany
- DZIF Group on Microbial Genome Research, Leibniz Institute DSMZ (Deutsche Sammlung von Mikroorganismen und Zellkulturen), Braunschweig, Germany
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