- 作者：Joseph B. Cantey ; Pranavi Sreeramoju ; Mambarambath Jaleel ; Sylvia Trevi?o ; Rita G ; er ; Linda S. Hynan ; Jennifer Hill ; Cari Brown ; Wendy Chung ; Jane D. Siegel ; Pablo J. S¨¢nchez
- 关键词：ESBL ; Extended-spectrum ¦Â-lactamase ; HCP ; Health care personnel ; KP ; Klebsiella pneumoniae ; MDROs ; Multidrug-resistant organisms ; NICU ; Neonatal intensive care unit ; PMH ; Parkland Memorial Hospital
- 刊名：The Journal of Pediatrics
- 出版年：2013
- 出版时间：September, 2013
- 年：2013
- 卷：163
- 期：3
- 页码：672-679.e3
- 全文大小：338 K
Objectives
To assess the effectiveness of a set of multidisciplinary interventions aimed at limiting patient-to-patient transmission of extended-spectrum ¦Â-lactamase-producing Klebsiella pneumoniae (ESBL-KP) during a neonatal intensive care unit (NICU) outbreak, and to identify risk factors associated with ESBL-KP colonization and disease in this setting.Study design
A 61-infant cohort present in the NICU during an outbreak of ESBL-KP from April 26, 2011, to May 16, 2011, was studied. Clinical characteristics were compared in infected/colonized infants and unaffected infants. A multidisciplinary team formulated an outbreak control plan that included (1) staff reeducation on recommended infection prevention measures; (2) auditing of hand hygiene and environmental services practices; (3) contact precautions; (4) cohorting of infants and staff; (5) alleviation of overcrowding; and (6) frequent NICU-wide screening cultures. Neither closure of the NICU nor culturing of health care personnel was instituted.
Results
Eleven infants in this level III NICU were infected/colonized with ESBL-KP. The index case was an 18-day-old infant born at 25 weeks' gestation who developed septicemia from ESBL-KP. Two other infants in the same room developed sepsis from ESBL-KP within 48 hours; both expired. Implementation of various infection prevention strategies resulted in prompt control of the outbreak within 3 weeks. The ESBL-KP isolates presented a single clone that was distinct from ESBL-KP identified previously in other units. Being housed in the same room as the index infant was the only risk factor identified by logistic regression analysis (P = .002).
Conclusion
This outbreak of ESBL-KP affected 11 infants and was associated with 2 deaths. Prompt control with eradication of the infecting strain from the NICU was achieved with multidisciplinary interventions based on standard infection prevention practices.