Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, USA.
J Pediatr. 2013 Sep;163(3):672-9.e1-3. doi: 10.1016/j.jpeds.2013.03.001. Epub 2013 Apr 10.
To assess the effectiveness of a set of multidisciplinary interventions aimed at limiting patient-to-patient transmission of extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) during a neonatal intensive care unit (NICU) outbreak, and to identify risk factors associated with ESBL-KP colonization and disease in this setting.
A 61-infant cohort present in the NICU during an outbreak of ESBL-KP from April 26, 2011, to May 16, 2011, was studied. Clinical characteristics were compared in infected/colonized infants and unaffected infants. A multidisciplinary team formulated an outbreak control plan that included (1) staff reeducation on recommended infection prevention measures; (2) auditing of hand hygiene and environmental services practices; (3) contact precautions; (4) cohorting of infants and staff; (5) alleviation of overcrowding; and (6) frequent NICU-wide screening cultures. Neither closure of the NICU nor culturing of health care personnel was instituted.
Eleven infants in this level III NICU were infected/colonized with ESBL-KP. The index case was an 18-day-old infant born at 25 weeks' gestation who developed septicemia from ESBL-KP. Two other infants in the same room developed sepsis from ESBL-KP within 48 hours; both expired. Implementation of various infection prevention strategies resulted in prompt control of the outbreak within 3 weeks. The ESBL-KP isolates presented a single clone that was distinct from ESBL-KP identified previously in other units. Being housed in the same room as the index infant was the only risk factor identified by logistic regression analysis (P = .002).
This outbreak of ESBL-KP affected 11 infants and was associated with 2 deaths. Prompt control with eradication of the infecting strain from the NICU was achieved with multidisciplinary interventions based on standard infection prevention practices.
评估一组旨在限制产超广谱β-内酰胺酶肺炎克雷伯菌（ESBL-KP）在新生儿重症监护病房（NICU）暴发期间患者间传播的多学科干预措施的有效性，并确定与该环境中 ESBL-KP 定植和疾病相关的危险因素。
在 2011 年 4 月 26 日至 5 月 16 日期间发生 ESBL-KP 暴发期间，对 NICU 中出现的 61 名婴儿进行了研究。比较了感染/定植婴儿和未受影响婴儿的临床特征。一个多学科小组制定了一项暴发控制计划，包括（1）对推荐的感染预防措施进行员工再教育；（2）审核手卫生和环境服务实践；（3）接触预防措施；（4）婴儿和工作人员分组；（5）缓解过度拥挤；和（6）经常进行 NICU 广泛筛查培养。既没有关闭 NICU，也没有对医护人员进行培养。
该三级 NICU 中有 11 名婴儿感染/定植 ESBL-KP。首例病例是一名 18 天大的婴儿，出生时胎龄为 25 周，因 ESBL-KP 败血症。同一病房的另外两名婴儿在 48 小时内发生 ESBL-KP 败血症；两人均死亡。实施各种感染预防策略后，暴发在 3 周内得到迅速控制。ESBL-KP 分离株呈现出与以前在其他单位鉴定的 ESBL-KP 不同的单一克隆。通过逻辑回归分析，与指数婴儿同住一室是唯一确定的危险因素（P =.002）。
此次 ESBL-KP 暴发共影响 11 名婴儿，其中 2 人死亡。通过基于标准感染预防实践的多学科干预措施，迅速控制并从 NICU 中根除了感染株。
