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.
Coovadia
Y M
YM
Department of Microbiology and Paediatrics, R.K. Khan Hospital, Durban, South Africa.
Johnson
A P
AP
Bhana
R H
RH
Hutchinson
G R
GR
George
R C
RC
Hafferjee
I E
IE
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