title: Klebsiella pneumoniae bloodstream infections among neonates in a high-risk nursery in Cali, Colombia.
abstract: OBJECTIVE
  To determine the cause of an outbreak of Klebsiella pneumoniae bloodstream infections (BSIs) among neonates in a high-risk nursery and to institute control measures.
  
  
  METHODS
  During the on-site investigation, a cohort study to identify risk factors for K. pneumoniae BSI, a point-prevalence study to assess K. pneumoniae colonization, a maternal cohort study to determine maternal K. pneumoniae colonization, and an observational study to evaluate healthcare worker (HCW) compliance with infection control practices were conducted.
  
  
  METHODS
  Neonates in a 40-bed high-risk nursery in a 700-bed university hospital in Cali, Colombia.
  
  
  METHODS
  Cohorting of neonates colonized with K. pneumoniae.
  
  
  RESULTS
  The overall K. pneumoniae BSI attack rate was 10 of 105 (9.5%). In the retrospective cohort study, the number of blood transfusions (OR, 3.1 per transfusion; P = .02; CI95, 1.4-9.7) and intravenous injections (OR, 1.2 per injection; P = .04; CI95, 1.0-1.5) were independently associated with K. pneumoniae BSI. The overall prevalence of K. pneumoniae colonization was 61% among neonates and 7% among mothers. During the HCW assessment, suboptimal intravenous therapy practices were observed. A cohorting intervention resulted in a significant reduction in K. pneumoniae colonization (12% vs 61%; RR, 0.19; P < .001). During the intervention period, no K. pneumoniae BSIs occurred.
  
  
  CONCLUSIONS
  This investigation suggested that the outbreak probably occurred due to widespread colonization and suboptimal infection control and intravenous therapy practices. Cohorting successfully reduced the overall prevalence of K. pneumoniae colonization and, along with improved infection control practices, probably prevented K. pneumoniae BSIs
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: Chesley
authors.initials: C
authors.lastname: Richards
authors.forename: Juan
authors.initials: J
authors.lastname: Alonso-Echanove
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Caicedo
authors.forename: William R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: D016470:Bacteremia / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D017848:Blood-Borne Pathogens; D002408:Catheters, Indwelling / Q000382:microbiology*; D015331:Cohort Studies; D003105:Colombia / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control; D004866:Equipment Contamination; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods / Q000592:standards; D017757:Infectious Disease Transmission, Professional-to-Patient; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000295:instrumentation; D007363:Intensive Care Units, Neonatal; D007710:Klebsiella Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D008297:Male