Analysis of three outbreaks due to Klebsiella species in a neonatal intensive care unit.
OBJECTIVE
To investigate the clinical, microbiological, and epidemiologic features of three outbreaks caused by Klesiella during 3 years.


METHODS
Neonatal intensive care unit of a university hospital.


METHODS
Thirty affected neonates.


METHODS
Data were collected through chart reviews and conversations with physicians. Screening samples were obtained from the staff, the neonates, and the environment. Antibiogram typing and arbitrarily primed polymerase chain reaction-based fingerprinting were used to type the strains.


RESULTS
The first outbreak had 13 K. pneumoniae strains isolated. The second outbreak had 10 K. oxytoca strains isolated. The third outbreak had 20 K. pneumoniae strains isolated. More than half of the patients had low birth weights, were premature, and underwent mechanical ventilation and intravenous catheterization. Approximately three-fourths of the patients died. The isolates tested were completely susceptible to meropenem, cefoxitin, and ciprofloxacin and were resistant to cephalothin. More than half of these strains were resistant to many beta-lactam antibiotics, amikacin, and trimethoprim/sulfamethoxazole. Typing procedures yielded 3 antibiotypes and 3 genotypes among the isolates of the first outbreak, 3 antibiotypes with 1 subtype and 2 genotypes with 1 subtype in the second outbreak, and 2 antibiotypes and 2 genotypes in the third outbreak.


CONCLUSIONS
Klebsiella outbreaks mainly affected premature neonates with intravenous catheters, mechanical ventilation, or both. The high mortality rate (76.7%) was notable. Resistance to multiple antibiotics, but mainly to broad-spectrum beta-lactam antibiotics, was observed, particularly in K. pneumoniae isolates. Molecular typing indicated that the three outbreaks were not related to one other.
Ayan
Melek
M
Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey.
Kuzucu
Cigdem
C
Durmaz
Riza
R
Aktas
Elif
E
Cizmeci
Zeynep
Z
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007709:Klebsiella / Q000145:classification* / Q000187:drug effects / Q000235:genetics*; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D013045:Species Specificity; D014421:Turkey / Q000453:epidemiology
D000900:Anti-Bacterial Agents