Extended spectrum beta-lactamase-producing Klebsiella pneumoniae outbreak reveals incubators as pathogen reservoir in neonatal care center.
Beds
/ adverse effects
Cross Infection
/ etiology
Disease Outbreaks
/ prevention & control
Drug Resistance, Multiple
Female
Humans
Incubators, Infant
/ adverse effects
Infant
Infant, Newborn
Infection Control
/ methods
Intensive Care Units, Neonatal
/ standards
Klebsiella Infections
/ epidemiology
Klebsiella pneumoniae
/ isolation & purification
Male
beta-Lactam Resistance
beta-Lactamases
/ metabolism
Incubator mattress
Molecular typing
Multi-drug-resistant bacteria
Neonatal intensive care unit
Outbreak
Steam-cleaner
Journal
European journal of pediatrics
ISSN: 1432-1076
Titre abrégé: Eur J Pediatr
Pays: Germany
ID NLM: 7603873
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
received:
01
07
2018
accepted:
15
01
2019
revised:
18
12
2018
pubmed:
24
1
2019
medline:
26
7
2019
entrez:
24
1
2019
Statut:
ppublish
Résumé
In the context of a 3-month extended-spectrum beta-lactamase-producing Klebsiella pneumonia (ESBL-KP) outbreak in a neonatal care center (NCC), hygiene practices and hospital environment were investigated. ESBL-KP strains isolated from patients and environment were compared by molecular typing. The density of incidence of multi-drug-resistant bacteria (MDRB) was calculated from January 2014 to September 2016. The 3-month ESBL-KP outbreak involved 19 patients. Clinical strains from the 19 patients displayed the same molecular profile between them, and with a strain isolated from an incubator after cleaning. Furthermore, 52.4% of incubator mattresses were positive for diverse pathogens. Hygiene practices were acceptable except for external practitioners and parents. In addition to classical infection control (IC) measures, the replacement of mattresses and the improvement of incubators disinfection stopped the outbreak. The protocol of disinfection was revised and microbiological control was implemented. A significant decrease of MDRB incidence was concomitant (p value = 0.03219) but 3 months later, MDRB incidence increased again.Conclusion: This investigation highlighted incubators and mattresses as critical materials associated to infectious risk in NCC. NCC and IC teams should implement efficient protocol for incubators disinfection and monitoring. What is Known: • Environment in neonatal intensive care units is often suspected as reservoir for Enterobacteriaceae outbreaks but is scarcely investigated. • Incubators and mattresses offer wet and warm conditions suitable for pathogens multiplication, but microbiological survey is not performed routinely for assessing bacterial contamination. What is New: • Incubators and mattresses serve as reservoir for pathogens and relay in outbreak. • An infection control protocol associating efficient disinfection and microbiology analysis is proposed.
Identifiants
pubmed: 30671695
doi: 10.1007/s00431-019-03323-w
pii: 10.1007/s00431-019-03323-w
doi:
Substances chimiques
beta-Lactamases
EC 3.5.2.6
Types de publication
Journal Article
Langues
eng
Pagination
505-513Références
Semin Perinatol. 2002 Oct;26(5):340-5
pubmed: 12452506
J Hosp Infect. 2003 Mar;53(3):198-206
pubmed: 12623321
Pediatr Infect Dis J. 2005 Jun;24(6):566-7
pubmed: 15933574
Clin Perinatol. 2008 Mar;35(1):223-49, x
pubmed: 18280884
J Hosp Infect. 2008 May;69(1):8-23
pubmed: 18355943
J Clin Microbiol. 2008 Sep;46(9):3112-5
pubmed: 18614656
J Hosp Infect. 2008 Sep;70(1):7-14
pubmed: 18632183
J Hosp Infect. 2009 May;72(1):17-22
pubmed: 19246120
J Hosp Infect. 2009 Aug;72(4):360-1
pubmed: 19540620
Infect Control Hosp Epidemiol. 2009 Aug;30(8):797-800
pubmed: 19552517
J Antimicrob Chemother. 2010 Jul;65(7):1368-71
pubmed: 20466850
Indian J Med Microbiol. 2010 Oct-Dec;28(4):380-4
pubmed: 20966575
Infection. 2011 Feb;39(1):29-34
pubmed: 21153042
Pediatr Crit Care Med. 2011 Nov;12(6):e282-6
pubmed: 21283042
J Hosp Infect. 2011 May;78(1):16-9
pubmed: 21392846
Am J Infect Control. 2011 Oct;39(8):655-662
pubmed: 21641089
Appl Environ Microbiol. 2011 Dec;77(24):8568-72
pubmed: 22003021
Early Hum Dev. 2012 Mar;88 Suppl 1:S41-9
pubmed: 22284985
World J Pediatr. 2012 Aug;8(3):268-71
pubmed: 22886203
Int J Environ Res Public Health. 2013 Feb 26;10(3):808-15
pubmed: 23442560
J Hosp Infect. 2013 Oct;85(2):149-54
pubmed: 23927924
New Microbiol. 2013 Oct;36(4):373-83
pubmed: 24177299
Microbiome. 2014 Jan 28;2(1):1
pubmed: 24468033
Am J Infect Control. 2014 Apr;42(4):421-2
pubmed: 24559597
Am J Infect Control. 2014 Apr;42(4):456-8
pubmed: 24679578
J Antimicrob Chemother. 2014 Aug;69(8):2230-7
pubmed: 24729603
Antimicrob Resist Infect Control. 2014 Jul 01;3:21
pubmed: 25089196
Clin Microbiol Rev. 2014 Oct;27(4):665-90
pubmed: 25278571
J Antimicrob Chemother. 2015 Nov;70(11):3027-31
pubmed: 26203181
J Hosp Infect. 2016 Jan;92(1):42-6
pubmed: 26238662
Adv Neonatal Care. 2015 Oct;15(5):324-35
pubmed: 26340035
PLoS One. 2015 Oct 20;10(10):e0140754
pubmed: 26485570
Am J Infect Control. 2016 Jul 1;44(7):837-9
pubmed: 26856469
Euro Surveill. 2016 Apr 28;21(17):
pubmed: 27168586
Diagn Microbiol Infect Dis. 2016 Oct;86(2):190-3
pubmed: 27492133
J Hosp Infect. 2018 Nov;100(3):363-364
pubmed: 30267741
J Clin Microbiol. 1994 Feb;32(2):301-5
pubmed: 8150938