Large oligoclonal outbreak due to Klebsiella pneumoniae ST14 and ST26 producing the FOX-7 AmpC ß-lactamase in a neonatal intensive care unit.

A large outbreak caused by expanded-spectrum cephalosporin-resistant Klebsiella pneumoniae (ESCRKP) was observed in a neonatal intensive care unit (NICU) in central Italy. The outbreak involved 127 neonates (99 colonizations and 28 infections, with seven cases of sepsis and two deaths) over a period of more than 2 years (February 2008 to April 2010). Characterization of the 92 nonredundant isolates that were available for further investigation revealed that all of them except one produced the FOX-7 AmpC-type ß-lactamase and belonged to either sequence type 14 (ST14) or ST26. All of the FOX-7-positive isolates were resistant to cefotaxime, ceftazidime, and piperacillin-tazobactam, while 76% were susceptible to cefepime, 98% to ertapenem, 99% to meropenem, and 100% to imipenem. The two carbapenem-nonsusceptible isolates had alterations in the genes encoding outer membrane proteins K35 and K36, which resulted in truncated and likely nonfunctional proteins. The outbreak was eventually controlled by the reinforcement of infection control measures based on a multitiered interventional approach. This is the first report of a large NICU outbreak caused by ESCRKP producing an AmpC-type enzyme. This study demonstrates that AmpC-type enzyme-producing strains can cause large outbreaks with significant morbidity and mortality effects (the mortality rate at 14 days was 28.5% for episodes of sepsis), and it underscores the role of laboratory-based surveillance and infection control measures to contain similar episodes.

Perinatal outcome and placental histological characteristics: a single-center study.

OBJECTIVE: Placental pathology assists in characterizing the antenatal environment and may provide information about the baby's subsequent development. We aim to assess whether histological patterns of placenta are associated with an increased risk of perinatal diseases and to evaluate how different patterns of placental dysfunction can affect the neurodevelopmental outcome. METHODS: We analyzed the histopathological characteristics of 105 singleton placentas from infants born between 23 and 31 weeks of gestation and we assessed pair-wise correlations with perinatal diseases. Estimated relative risks were calculated from odds ratios. RESULTS: Histological chorioamnionitis (CA group) was detected on 51 of 100 placentas tested. Lesions of uteroplacental circulation (abruption, infarction or thrombosis, perivillous fibrin deposition, syncytial knots; vasculopathy group) were detected on 29. 25 normal placentas served as controls. The incidence of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) was higher in CA than in control group. The risk of developing retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and PDA was higher in CA than in vasculopathy group. CONCLUSIONS: At low gestational age CA, rather than placental lesions of vasculopathy, negatively impacts perinatal outcome. Clinical significance of histologic vasculopathy remains questionable. Other pathophysiological mechanisms than those associated with placental changes may occur following dysfunction of uteroplacental circulation.

Inflammation-induced immune suppression of the fetus: a potential link between chorioamnionitis and postnatal early onset sepsis.

Chorioamnionitis which results from microbial invasion of the amniotic cavity is the most frequent cause of preterm birth. Chorioamnionitis is associated with an increased risk of early-onset sepsis but the mechanisms underlying this association remain largely unknown. We hypothesize that developmental alterations of fetal organs and the immune system in the course of chorioamnionitis determine the risk of development of early onset sepsis. The purpose of this review is therefore to summarize the consequences of chorioamnionitis on fetal development and speculate how those antenatal changes might predispose to early onset sepsis.

Efficacy of Arnica Echinacea powder in umbilical cord care in a large cohort study.

BACKGROUND: Today healthy newborns are discharged after 48 h-72 h of life until umbilical cord (UC) detachment. Complications due to an inappropriate management are: erythema, edema, bleeding, omphalitis and sepsis. Hence the importance of a safe, effective, easy to do, and cheap method. AIM: This study tests the effects and the efficacy of arnica echinacea powder by evaluating the time of cord detachment and the risk of side effects in a large cohort of newborns. METHODS: 6323 babies were treated with Arnica Echinacea powder twice a day until cord stump detachment. Medications started in hospital ward and continued at home until stump detachment. RESULTS: The UC stump detachment occurred in 89.09% of newborns during the first 4 days of life. This percentage increase to 96.13% at 6 days. CONCLUSIONS: Our study demonstrates the efficacy and the safety of arnica echinacea in UC separation. No infections or even bacterial colonizations were found. The use of arnica echinacea reduces hospital costs as a consequence of complications. In addition arnica use is well received by medical staff and parents. In conclusion due to its potential benefits, low cost and feasibility, we recommend the use of arnica echinacea powder as routine procedure in all nurseries.