Short report
Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

https://doi.org/10.1016/j.jhin.2013.08.004Get rights and content

Summary

This article reports an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) sequence type (ST) 258 in a neonatal intensive care unit (NICU) in Palermo, Italy. KPC-Kp ST258 was detected by an active surveillance culture programme. Between 18th September and 14th November 2012, KPC-Kp was isolated from 10 out of 54 neonates admitted in the outbreak period. No cases of infection were recorded. Male sex was associated with colonization, whereas administration of ampicillin– sulbactam plus gentamicin was protective. Infection control interventions interrupted the spread of KPC-Kp without the need to close the NICU to new admissions.

Introduction

Over the last decade resistance to carbapenems due to the production of Klebsiella pneumoniae carbapenemases (KPCs) has spread worldwide.1 KPCs are often associated with internationally successful K. pneumoniae clones, such as sequence type (ST) 258, which are endemic in many geographic areas, including Italy.1

Gram-negative bacteria cause ∼20–40% of all late-onset sepsis in the neonatal intensive care units (NICUs) and are frequently associated with adverse clinical outcomes.2, 3 Colonization with multidrug-resistant (MDR) Gram-negative organisms is also, therefore, of great concern, due to the possibility of infection.4 Additionally, colonized infants can sustain unrecognized chains of transmission and create long-term reservoirs of MDR bacteria and drug resistance genes.3

We report an outbreak of colonization by KPC-Kp ST258 in the NICU of the University Hospital of Palermo, Italy, and describe the measures that allowed for its successful control.

Section snippets

Setting

The tertiary-level NICU of the University Hospital Azienda Ospedaliero–Universitaria Policlinico ‘P. Giaccone’, Palermo, Italy, admits about 250 infants annually. Because it is associated with the regional reference centre for genetic diseases, the NICU has a high prevalence of neonates with malformations (∼20%), as well as of admissions referred from elsewhere (∼35%). A further 20% of patients have complex conditions requiring specialist medical or surgical care. The NICU includes one

Outbreak description and infection control interventions

Between 18th September and 14th November 2012, KPC-Kp was isolated from 10 neonates. The epidemic curve is illustrated in Figure 1. The index cases were two neonates born elsewhere, who had been admitted to the NICU on 6th and 11th September, respectively, and tested positive for KPC-Kp on 18th September. They had been transferred from another general hospital and from a private maternity clinic, respectively, where no cases of infection by KPC-Kp had been reported. Infection prevention and

Discussion

KPC-Kp infections are increasingly frequent worldwide, representing a major clinical and public health threat. Italy ranks third among the European countries, after Greece and Cyprus, by prevalence of KPC-Kp infections.7 Previous reports have described the epidemic spread of KPC-Kp ST258 in different healthcare settings in Sicily.8, 9 However, to the best of our knowledge, this is the first report of an outbreak of colonization by KPC-Kp in NICU. Interestingly, the emergence of the outbreak

Conflict of interest statement

None declared.

Funding sources

This work was supported by institutional resources.

References (10)

There are more references available in the full text version of this article.

Cited by (0)

View full text