RESUMO
We describe the outbreak of a pan-susceptible Klebsiella pneumoniae strain in a neonatal intensive care unit. A total of 7 neonates developed bacteraemia (37% attack rate), of whom 3 died (43% case fatality rate). A birth weight < 1500 g was the only statistically significant risk factor. Despite an extensive environmental investigation, the source was not identified.
Assuntos
Antibacterianos/farmacologia , Bacteriemia/epidemiologia , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Bacteriemia/microbiologia , Estudos de Casos e Controles , Infecção Hospitalar/microbiologia , Feminino , Humanos , Recém-Nascido , Terapia Intensiva Neonatal , Infecções por Klebsiella/microbiologia , Masculino , Testes de Sensibilidade Microbiana , Fatores de Risco , Análise de SobrevidaRESUMO
BACKGROUND: This report describes 3 consecutive outbreaks caused by genetically unrelated Serratia marcescens clones that occurred in a neonatal intensive care unit (NICU) over a 35-month period. METHODS: Carriage testing in neonates and health care workers and environmental investigation were performed. An unmatched case-control study was conducted to identify risk factors for S marcescens isolation. RESULTS: During the 35-month period, there were 57 neonates with S marcescens isolation in the NICU, including 37 carriers and 20 infected neonates. The prevalence rate of S marcescens isolation was 12.3% in outbreak 1, 47.4% in outbreak 2, and 42% in outbreak 3. Nine of the 20 infected neonates died (45% case fatality rate). A total of 10 pulsed field gel electrophoresis types were introduced in the NICU in various times; 4 of these types accounted for the 9 fatal cases. During outbreak 3, a type VIII S marcescens strain, the prevalent clinical clone during this period, was detected in the milk kitchen sink drain. Multiple logistic regression revealed that the only statistically significant factor for S marcencens isolation was the administration of total parenteral nutrition. CONCLUSIONS: Total parenteral nutrition solution might constitute a possible route for the introduction of microorganisms in the NICU. Gaps in infection control should be identified and strict measures implemented to ensure patient safety.
Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Tipagem Molecular , Infecções por Serratia/epidemiologia , Serratia marcescens/classificação , Serratia marcescens/isolamento & purificação , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Estudos de Casos e Controles , Infecção Hospitalar/microbiologia , Contaminação de Medicamentos , Microbiologia Ambiental , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Epidemiologia Molecular , Soluções de Nutrição Parenteral , Fatores de Risco , Infecções por Serratia/microbiologia , Serratia marcescens/genéticaRESUMO
In June 2010, a severe outbreak of 13 cases of post-cataract surgery endophthalmitis caused by multidrug-resistant Pseudomonas aeruginosa occurred. Pulse-field gel electrophoresis in eye isolates found 95% genetic similarity; however, extensive environmental and carriage investigation revealed no source of infection.