Multiresistant Klebsiella pneumoniae in a neonatal nursery: the importance of maintenance of infection control policies and procedures in the prevention of outbreaks.
During a 3-week period, nine babies in the neonatal unit of a large teaching hospital in Durban were infected or colonized with Klebsiella pneumoniae resistant to a range of antimicrobial agents including amikacin and cefotaxime. Resistance to cefotaxime was reduced by clavulanic acid in vitro suggesting production of extended-spectrum beta-lactamase activity. All the isolates had the same antibiotic resistance profile, belonged to the same serotype (K17), were non-typable with bacteriophages, and had identical plasmid profiles indicating that they belonged to the same strain. During a 1-day microbiological survey of the ward, the outbreak strain was isolated from the nose and hands of a doctor based in the nursery and from the hands of a nurse and the mother of an infected baby. The strain was also isolated from nine of 67 environmental samples. Investigation revealed that infection control practices which had been instituted following a previous outbreak in the nursery with multi-resistant methicillin-resistant Staphylococcus aureus (MRSA) were not being adhered to. The re-introduction and strict enforcement of these procedures under the supervision of an Infection Control Nurse resulted in the abrupt end of the outbreak.
Department of Microbiology and Paediatrics, R.K. Khan Hospital, Durban, South Africa.
Y M
YM
Coovadia
A P
AP
Johnson
R H
RH
Bhana
G R
GR
Hutchinson
R C
RC
George
I E
IE
Hafferjee
D000583:Amikacin / Q000494:pharmacology; D002353:Carrier State / Q000382:microbiology; D002439:Cefotaxime / Q000494:pharmacology; D003428:Cross Infection / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission; D004196:Disease Outbreaks / Q000517:prevention & control*; D004352:Drug Resistance, Microbial; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007710:Klebsiella Infections / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D009725:Nurseries, Hospital; D013019:South Africa
D000583:Amikacin; D002439:Cefotaxime