Original ArticlePrompt Control of an Outbreak Caused by Extended-Spectrum β-Lactamase–Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit
Section snippets
Methods
PMH is a 672-bed public tertiary care center that provides a wide range of services, including high-risk obstetrics. The PMH NICU is a 90-bed level 3C, predominantly inborn unit with approximately 1200 admissions annually (Figure 1; available at www.jpeds.com). The NICU consists of 7 bays (“rooms” hereinafter) each with a maximum capacity of 12 infants depending on acuity (Figure 1, rooms A to G; Table I). There is 1 separate single bed, in a negatively ventilated isolation room (room H). A
Results
The index patient (infant 1; Table II; available at www.jpeds.com) was an 18-day-old infant born at 25 weeks' gestation (birth weight, 790 g) who developed respiratory distress, hypotension, and metabolic acidosis on April 26. Aerobic cultures were obtained from a peripherally inserted central venous catheter and peripheral blood, urine, and endotracheal tube aspirate, and antibiotic therapy with oxacillin and gentamicin was initiated. On April 28, Gram-negative rods were identified from both
Discussion
It has been suggested that there is a small but consistent background rate of gram-negative MDROs that colonize infants in NICUs, but with the maintenance of optimal infection prevention and control practices, horizontal transmission is low and colonization is short-lived.21, 22 In our NICU, ESBL-KP had not been identified previously from any clinical culture, although surveillance cultures had not been performed routinely before the outbreak. Although the source of the outbreak remains
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Next Steps for Health Care-Associated Infections in the Neonatal Intensive Care Unit
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2021, Infectious Disease Clinics of North AmericaCitation Excerpt :In a controlled study conducted at 2 hospitals in France, the rate of ESBL acquisitions was not associated with CP implementation.75 However, some national guidelines (eg, in Switzerland) recommend CPs for hospitalized ESBL carriers; and during outbreaks or among high-risk populations (eg, neonates, severely immunosuppressed), CPs may still play a role in preventing ESBL acquisition.76–78 Overuse of CPs has the potential to cause harm.
Antibiotic stewardship in neonates and in neonatal intensive care units
2020, Seminars in PerinatologyDrugs for the Prevention and Treatment of Sepsis in the Newborn
2019, Clinics in PerinatologyCitation Excerpt :Various medical organizations have all recognized that judicious use of antibiotics is needed to prevent the spread of antimicrobial-resistant organisms.11,12 Single-center and time-trend studies reveal increasing antimicrobial resistance in neonatal late-onset infections and increasing resistance among GBS and Escherichia coli isolates in early-onset infections.13–17 The known resistance patterns of common pathogens combined with local antibiograms can inform antibiotic choices of empiric and definitive therapy (Tables 2 and 3).
Risk factors for infection and/or colonisation with extended-spectrum β-lactamase-producing bacteria in the neonatal intensive care unit: a meta-analysis
2017, International Journal of Antimicrobial AgentsCitation Excerpt :The included studies were published from 2003–2014. The study periods spanned from 1997 to 2011 and the studies were conducted in different countries, including China [28,30,32], Italy [23], India [24,31], Brazil [25,26], Norway [13], Malaysia [27], Egypt [14], Saudi Arabia [29], Sweden [3] and the USA [33]. Case–control study designs were used in seven studies, whereas the other seven studies used cohort designs.
The authors declare no conflicts of interest.