title: Prompt control of an outbreak caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit.
abstract: OBJECTIVE
  To assess the effectiveness of a set of multidisciplinary interventions aimed at limiting patient-to-patient transmission of extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) during a neonatal intensive care unit (NICU) outbreak, and to identify risk factors associated with ESBL-KP colonization and disease in this setting.
  
  
  METHODS
  A 61-infant cohort present in the NICU during an outbreak of ESBL-KP from April 26, 2011, to May 16, 2011, was studied. Clinical characteristics were compared in infected/colonized infants and unaffected infants. A multidisciplinary team formulated an outbreak control plan that included (1) staff reeducation on recommended infection prevention measures; (2) auditing of hand hygiene and environmental services practices; (3) contact precautions; (4) cohorting of infants and staff; (5) alleviation of overcrowding; and (6) frequent NICU-wide screening cultures. Neither closure of the NICU nor culturing of health care personnel was instituted.
  
  
  RESULTS
  Eleven infants in this level III NICU were infected/colonized with ESBL-KP. The index case was an 18-day-old infant born at 25 weeks' gestation who developed septicemia from ESBL-KP. Two other infants in the same room developed sepsis from ESBL-KP within 48 hours; both expired. Implementation of various infection prevention strategies resulted in prompt control of the outbreak within 3 weeks. The ESBL-KP isolates presented a single clone that was distinct from ESBL-KP identified previously in other units. Being housed in the same room as the index infant was the only risk factor identified by logistic regression analysis (P = .002).
  
  
  CONCLUSIONS
  This outbreak of ESBL-KP affected 11 infants and was associated with 2 deaths. Prompt control with eradication of the infecting strain from the NICU was achieved with multidisciplinary interventions based on standard infection prevention practices.
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, USA. Pablo.Sanchez@utsouthwestern.edu
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Cantey
authors.forename: Pranavi
authors.initials: P
authors.lastname: Sreeramoju
authors.forename: Mambarambath
authors.initials: M
authors.lastname: Jaleel
authors.forename: Sylvia
authors.initials: S
authors.lastname: Treviño
authors.forename: Rita
authors.initials: R
authors.lastname: Gander
authors.forename: Linda S
authors.initials: LS
authors.lastname: Hynan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hill
authors.forename: Cari
authors.initials: C
authors.lastname: Brown
authors.forename: Wendy
authors.initials: W
authors.lastname: Chung
authors.forename: Jane D
authors.initials: JD
authors.lastname: Siegel
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods* / Q000458:organization & administration; D007363:Intensive Care Units, Neonatal; D007710:Klebsiella Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D007711:Klebsiella pneumoniae / Q000302:isolation & purification / Q000378:metabolism; D016015:Logistic Models; D008297:Male; D010348:Patient Care Team; D012307:Risk Factors; D013781:Texas; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D015415:Biomarkers; D001618:beta-Lactamases
keywords: ESBL; Extended-spectrum β-lactamase; HCP; Health care personnel; KP; Klebsiella pneumoniae; MDROs; Multidrug-resistant organisms; NICU; Neonatal intensive care unit; PMH; Parkland Memorial Hospital