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An outbreak of gentamicin-resistant Klebsiella pneumoniae: analysis of control measures
Abstract:
In April 1978, a strain of gentamicin-resistant Klebsiella pneumoniae (GRK) was introduced into the neonatal intensive care unit of Henry Ford Hospital. An additional ten cases of GRK occurred over the subsequent 16 months and intestinal colonization occurred in up to 91% of admissions per month. All GRK were susceptible to amikacin and were capsular serotype 19. Though hand contamination of hospital personnel with GRK was documented, increased handwashing practices did not reduce colonization rates of neonates with the epidemic strain. Intestinal carriage persisted for up to ten months and could not be eradicated by administering oral colistin sulfate. Discontinuation of gentamicin and utilization of amikacin were associated with a significant reduction in colonization with GRK (p less than 0.05). However, the only control measure that prevented both new cases and colonization with the epidemic strain was the utilization of a strict cohort system.
Insights
Gentamicin-resistant Klebsiella pneumoniae (GRK) outbreaks in NICUs are challenging. Strict cohorting effectively prevented new cases and colonization, unlike handwashing or antibiotics alone.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Neonatal Care
Background:
- A gentamicin-resistant Klebsiella pneumoniae (GRK) strain emerged in a neonatal intensive care unit (NICU) in April 1978.
- This strain caused 10 additional cases over 16 months, with monthly intestinal colonization rates reaching 91% in neonates.
Purpose of the Study:
- To investigate the epidemiology and control of a gentamicin-resistant Klebsiella pneumoniae (GRK) outbreak in a NICU.
- To evaluate the effectiveness of various interventions, including hand hygiene, antibiotic therapy, and cohorting, in controlling GRK spread.
Main Methods:
- Retrospective analysis of GRK cases and colonization rates.
- Assessment of hand contamination in hospital personnel.
- Evaluation of antibiotic susceptibility and treatment outcomes.
- Comparison of control measures including handwashing, antibiotic changes, and cohorting.
Main Results:
- All GRK isolates were susceptible to amikacin and belonged to capsular serotype 19.
- Increased handwashing did not reduce neonatal colonization rates.
- Oral colistin sulfate failed to eradicate intestinal carriage.
- Discontinuing gentamicin and using amikacin significantly reduced GRK colonization (p < 0.05).
- A strict cohort system was the only measure that prevented new cases and colonization.
Conclusions:
- Gentamicin-resistant Klebsiella pneumoniae (GRK) outbreaks pose a significant threat in NICUs.
- Standard infection control measures like handwashing were insufficient.
- Antibiotic stewardship, including the use of amikacin, showed some success.
- Strict cohorting emerged as the most effective strategy for controlling GRK outbreaks in this NICU setting.