title: An outbreak of SHV-5 producing Klebsiella pneumoniae in a neonatal intensive care unit; meropenem failed to avoid fecal colonization.
abstract: An outbreak of extended-spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae (ESBL-Kp) in a neonatal intensive care unit prompted a prospective surveillance study between 12th September and 6th October 2003. Surveillance was carried out by obtaining stool samples twice a week. The DNA relatedness of the isolates was shown by random amplified polymorphic DNA comparison (ERIC-PCR). ESBL production was identified by clavulanate synergy, isoelectric focusing, PCR and sequence analysis. During the study period, 49 neonates were hospitalized in the neonatal intensive care unit (NICU). In the first 20-day period, five neonates were infected with ESBL-Kp. The first patient treated with third generation cephalosporin and the second patient treated with meropenem died. While all three infected survivors were clinically improving, the digestive tracts were being colonized by SHV-5 producing Klebsiella. In the next period of the study, five neonates were colonized by ESBL-Kp as well. Univariate comparison of risk factors between colonized and non-colonized neonates was not significant. A total of 24 colonally related ESBL-Kp have been recovered from clinical materials and stool samples. This study demonstrated that parenterally applied meropenem, though successful in treating the systemic illness, might fail to protect the digestive tract from colonization of ESBL-Kp.
authors.affiliation: Infeksiyon Hastaliklari & Klinik Mikrobiyoloji AD, Kocaeli Universitesi, Kocaeli, Turkey.
authors.forename: Sibel
authors.initials: S
authors.lastname: Gundes
authors.forename: Ayse Engin
authors.initials: AE
authors.lastname: Arisoy
authors.forename: Fetiye
authors.initials: F
authors.lastname: Kolayli
authors.forename: Emel
authors.initials: E
authors.lastname: Karaali
authors.forename: Gulcan
authors.initials: G
authors.lastname: Turker
authors.forename: Ahmet
authors.initials: A
authors.lastname: Sanic
authors.forename: Emin Sami
authors.initials: ES
authors.lastname: Arisoy
authors.forename: Haluk
authors.initials: H
authors.lastname: Vahaboglu
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000032:analysis / Q000737:chemistry / Q000302:isolation & purification; D004196:Disease Outbreaks; D005243:Feces / Q000382:microbiology*; D005260:Female; D005798:Genes, Bacterial; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007525:Isoelectric Focusing; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D007711:Klebsiella pneumoniae / Q000201:enzymology / Q000254:growth & development / Q000302:isolation & purification*; D008297:Male; D000077731:Meropenem; D017720:Molecular Epidemiology; D016133:Polymerase Chain Reaction; D019105:Random Amplified Polymorphic DNA Technique; D017422:Sequence Analysis, DNA; D013845:Thienamycins / Q000627:therapeutic use*; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000302:isolation & purification / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D004269:DNA, Bacterial; D013845:Thienamycins; C117193:beta-lactamase SHV-5; D001618:beta-Lactamases; D000077731:Meropenem