title: An outbreak of Klebsiella pneumoniae late-onset sepsis in a neonatal intensive care unit in Guatemala.
abstract: BACKGROUND
  Gram-negative bloodstream infections are an important cause of neonatal mortality. In October 2009, we investigated a Klebsiella spp outbreak in a neonatal intensive care unit in Guatemala.
  
  
  METHODS
  Probable cases were defined as a Klebsiella spp isolated from blood in neonates aged <28 days in the neonatal intensive care unit between October 1 and November 10, 2009; confirmed cases were identified as Klebsiella pneumoniae. Clinical data were abstracted from medical charts. K pneumoniae isolates were genotyped by pulsed-field gel electrophoresis (PFGE) and tested for antimicrobial susceptibility. Infection control practices were inspected.
  
  
  RESULTS
  There were 14 confirmed cases. The median age at onset of infection was 3 days (range, 2-8 days). Nine patients died (64%). K pneumoniae isolates were resistant to multiple antimicrobials. PFGE revealed 2 distinct clusters. Breaches in infection control procedures included inappropriate intravenous solution use and inadequate hand hygiene and contact precautions.
  
  
  CONCLUSIONS
  We report a K pneumoniae outbreak with high neonatal mortality in Guatemala. PFGE clustering suggested a common source possibly related to reuse of a single-use intravenous medication or solution. The risk for K pneumoniae bloodstream infections in neonates in low-resource settings where sharing of solutions is common needs to be emphasized.
authors.affiliation: Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala. jgray@slhs.org
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gray
authors.forename: Wences
authors.initials: W
authors.lastname: Arvelo
authors.forename: John
authors.initials: J
authors.lastname: McCracken
authors.forename: Beatriz
authors.initials: B
authors.lastname: Lopez
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Lessa
authors.forename: Brandon
authors.initials: B
authors.lastname: Kitchel
authors.forename: Betty
authors.initials: B
authors.lastname: Wong
authors.forename: Lissette
authors.initials: L
authors.lastname: Reyes
authors.forename: Kim
authors.initials: K
authors.lastname: Lindblade
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D004196:Disease Outbreaks; D004340:Drug Contamination; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D008297:Male; D008826:Microbial Sensitivity Tests; D058889:Molecular Typing; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents