title: Extended-spectrum β-lactamase-producing Klebsiella pneumoniae in the neonatal intensive care unit: does vancomycin play a role?
abstract: BACKGROUND
  Extended-spectrum β-lactamase (ESBL)-producing Klebsiella species cause worldwide problems in neonatal intensive care units (NICUs). This study aimed to determine possible risk factors for infection or colonization with ESBL-producing Klebsiella pneumoniae (ESBLKp) during an outbreak in the NICU.
  
  
  METHODS
  A retrospective cohort study was conducted among neonates admitted to the NICU of a teaching hospital in Riyadh, Saudi Arabia, during an outbreak of ESBLKp from April to July 2008. The incidence density ratio was calculated to determine possible predictors of ESBLKp colonization or infection.
  
  
  RESULTS
  During 2,265 person-days of follow-up of 118 neonates, 4 became infected, and 8 were colonized with ESBLKp. Univariate analyzes revealed that, among 14 neonates who were treated with vancomycin, 9 (64.3%) developed infection or colonization with ESBLKp, whereas, among 104 neonates who were not treated with vancomycin, 3 (2.9%) were affected, with an incidence density ratio of 4.22 (95% confidence interval: 1.47-5.15). Parenteral feeding and mechanical ventilation were found to be marginally significant risk factors.
  
  
  CONCLUSIONS
  Treatment with vancomycin appears to be a risk factor for infection or colonization with ESBLKp in the NICU setting.
authors.affiliation: Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Ali M
authors.initials: AM
authors.lastname: Somily
authors.affiliation: Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Alsubaie
authors.affiliation: Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Electronic address: abinsaid@ksu.edu.sa.
authors.forename: Abdulaziz A
authors.initials: AA
authors.lastname: BinSaeed
authors.affiliation: Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Armen A
authors.initials: AA
authors.lastname: Torchyan
authors.affiliation: Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Fahad A
authors.initials: FA
authors.lastname: Alzamil
authors.affiliation: Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: AbdulKarim I
authors.initials: AI
authors.lastname: Al-Aska
authors.affiliation: Department of Infection Control, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Fatimah S
authors.initials: FS
authors.lastname: Al-Khattaf
authors.affiliation: Department of Infection Control, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Lyla A
authors.initials: LA
authors.lastname: Khalifa
authors.affiliation: Department of Infection and Immunity, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Sahar I
authors.initials: SI
authors.lastname: Al-Thawadi
authors.affiliation: Department of Infection and Immunity, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Alwaleed A
authors.initials: AA
authors.lastname: Alaidan
authors.affiliation: Department of Infection and Immunity, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Mohammed N
authors.initials: MN
authors.lastname: Al-Ahdal
authors.affiliation: Department of Infection and Immunity, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Al-Qahtani
authors.affiliation: Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Murray
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004196:Disease Outbreaks; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D014640:Vancomycin / Q000008:administration & dosage*; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D001618:beta-Lactamases
keywords: Antibiotics; Colonization; Infection; Outbreak; Saudi Arabia