title: Successful control of a neonatal outbreak caused mainly by ST20 multidrug-resistant SHV-5-producing Klebsiella pneumoniae, Greece.
abstract: BACKGROUND
  Extended spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-Kp) infection can cause significant morbidity and mortality in neonates. We investigated a nosocomial ESBL-Kp outbreak in a neonatal intensive care unit (NICU) of the University Hospital of Larissa (UHL), Central Greece.
  
  
  METHODS
  A total of sixty-four ESBL-Kp were studied; twenty six isolates were recovered from the NICU and were compared with thirty-eight randomly selected isolates from different wards of the hospital during the period March- December 2012. All isolates were characterized by antimicrobial susceptibility testing, ESBL-production by double-disk synergy test, molecular typing using BOX-PCR, whereas selected isolates were further characterized by beta lactamase and virulence gene content, multilocus sequence typing and phylogenetic analysis. All neonates affected by ESBL-Kp were put under strict contact isolation, along with appropriate infection control measures.
  
  
  RESULTS
  The outbreak strain of ST20 multidrug-resistant SHV-5-producing K. pneumoniae was identified in all infected (n = 13) and three colonized neonates. A novel ST (ST1114) was also identified among SHV-5 producers (n = 10) recovered from nine colonized infants, but it was not related with ST20. Both STs were identified only in the NICU and not in other wards of the hospital. No ESBL-Kp were isolated from the hands of the nursing staff and the environment. Although we were not able to identify the source of the outbreak, no ESBL-Kp were isolated in the NICU after this period and we assumed that the outbreak was successfully controlled. All neonates received parenteral nutrition and most of them were delivered by caesarean section and showed low gestational age (<32 weeks) and low birth weights (<1500 g).
  
  
  CONCLUSIONS
  According to our knowledge, this is the first description of an outbreak of multidrug-resistant SHV-5 producing K. pneumoniae assigned to ST20.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Mavroidi
authors.forename: Apostolos
authors.initials: A
authors.lastname: Liakopoulos
authors.forename: Antonios
authors.initials: A
authors.lastname: Gounaris
authors.forename: Maria
authors.initials: M
authors.lastname: Goudesidou
authors.forename: Katerina
authors.initials: K
authors.lastname: Gaitana
authors.forename: Vivi
authors.initials: V
authors.lastname: Miriagou
authors.affiliation: Department of Microbiology, University Hospital of Larissa, Larissa, Greece. petinaki@med.uth.gr.
authors.forename: Efthymia
authors.initials: E
authors.lastname: Petinaki
mesh_terms: D002405:Catheterization, Central Venous; D002585:Cesarean Section; D015505:Chest Tubes; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D004269:DNA, Bacterial / Q000302:isolation & purification; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005865:Gestational Age; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D017053:Infection Control; D007363:Intensive Care Units, Neonatal; D007440:Intubation; D007710:Klebsiella Infections / Q000453:epidemiology*; D007711:Klebsiella pneumoniae / Q000201:enzymology / Q000302:isolation & purification*; D008297:Male; D010288:Parenteral Nutrition; D012307:Risk Factors; D001618:beta-Lactamases / Q000235:genetics / Q000302:isolation & purification*
chemical_list: D004269:DNA, Bacterial; C117193:beta-lactamase SHV-5; D001618:beta-Lactamases
references.citation: Antimicrob Agents Chemother. 2009 Aug;53(8):3365-70
references.pmid: 19506063
references.citation: Clin Microbiol Infect. 2010 Feb;16(2):112-22
references.pmid: 20085605
references.citation: J Antimicrob Chemother. 2013 Nov;68(11):2487-92
references.pmid: 23788480
references.citation: Euro Surveill. 2008 Nov 20;13(47):
references.pmid: 19021958
references.citation: J Antimicrob Chemother. 1999 Oct;44(4):489-99
references.pmid: 10588311
references.citation: J Antimicrob Chemother. 1990 Mar;25(3):343-51
references.pmid: 2187011
references.citation: APMIS. 2012 Aug;120(8):612-21
references.pmid: 22779683
references.citation: Int J Antimicrob Agents. 2012 Jun;39(6):543-5
references.pmid: 22534506
references.citation: Int J Antimicrob Agents. 2012 Feb;39(2):178-80
references.pmid: 22104281
references.citation: Emerg Infect Dis. 2007 Jul;13(7):986-93
references.pmid: 18214169
references.citation: J Antimicrob Chemother. 2009 Sep;64(3):524-8
references.pmid: 19525516
references.citation: J Clin Microbiol. 2005 Aug;43(8):4178-82
references.pmid: 16081970
references.citation: J Clin Microbiol. 1996 Mar;34(3):564-8
references.pmid: 8904415
references.citation: J Clin Microbiol. 2009 Oct;47(10):3353-7
references.pmid: 19710276
references.citation: FEMS Microbiol Rev. 2011 Sep;35(5):736-55
references.pmid: 21303394
references.citation: J Antimicrob Chemother. 2012 Dec;67(12):2843-7
references.pmid: 22893681
references.citation: Mol Biol Evol. 2007 Aug;24(8):1596-9
references.pmid: 17488738
references.citation: Neonatology. 2013;103(2):155-60
references.pmid: 23235260
references.citation: Drugs. 2003;63(4):353-65
references.pmid: 12558458
references.citation: PLoS One. 2009;4(3):e4982
references.pmid: 19319196
references.citation: Infect Control Hosp Epidemiol. 2004 Mar;25(3):210-5
references.pmid: 15061412
references.citation: J Clin Microbiol. 2003 Mar;41(3):1161-6
references.pmid: 12624046
references.citation: J Pediatr. 2013 Sep;163(3):672-9.e1-3
references.pmid: 23582136
references.citation: Antimicrob Resist Infect Control. 2013 Mar 21;2(1):8
references.pmid: 23517816
references.citation: Am J Infect Control. 2007 Apr;35(3):172-6
references.pmid: 17433940
references.citation: J Antimicrob Chemother. 2012 May;67(5):1114-20
references.pmid: 22334607