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An outbreak of antibiotic multiresistant Klebsiella at the Neonatal Intensive Care Unit, Kaplan Hospital, Rehovot,
O Flidel-Rimon1, E Leibovitz, A Juster-Reicher
1Department of Neonatology, Kaplan Hospital, Rehovot, Israel.
Insights
Antibiotic-resistant Klebsiella infections affected premature infants, leading to fatalities. A NICU closure and revised antibiotic protocols, including imipenem, helped control the outbreak and prevent future neonatal infections.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Microbiology
Background:
- An outbreak of systemic infections caused by multiple-resistant Klebsiella (MRK) occurred in a neonatal intensive care unit (NICU).
- The affected infants were predominantly premature, with a significant proportion weighing less than 1100 grams and having prior antibiotic exposure.
Purpose of the Study:
- To investigate the characteristics of MRK infections in neonates.
- To identify effective treatment strategies and inform antibiotic protocols for neonatal sepsis.
Main Methods:
- Retrospective analysis of clinical data from infants with MRK infections between November 1991 and April 1992.
- Microbiological analysis of isolates from blood, tracheal secretions, stool, and cerebrospinal fluid.
- Evaluation of antibiotic susceptibility patterns and empiric therapy efficacy.
Main Results:
- Eight infants developed MRK infections, with isolates resistant to multiple antibiotics including ampicillin, mezlocillin, cefotaxime, ceftazidime, and amikacin.
- All MRK isolates were sensitive to quinolones and imipenem. Four infants died, with their isolates only sensitive to quinolones and imipenem.
- Empiric antibiotic therapy was often inappropriate, highlighting the need for revised treatment guidelines.
Conclusions:
- The emergence of MRK necessitates a rational approach to empiric antibiotic selection in neonatal infections.
- Strict infection control measures, including hand hygiene and NICU closure, were crucial in terminating the outbreak.
- Updated empiric antibiotic protocols, incorporating agents like imipenem, are vital for managing resistant bacterial infections in high-risk neonatal populations.
Abstract:
From November 1991 through April 1992, 8 infants developed systemic infections due to antibiotic multiple resistant Klebsiellaa (MRK). All were premature and 6 of the 8 weighed less than 1100 g; 7 of the 8 had received previous antibiotic therapy. Five infections occurred during the first week of life. MRK were isolated from blood (8 cases), tracheal secretions (TS-6), stool (3), and CSF (1). All Klebsiella blood isolates were resistant to ampicillin, mezlocillin, and cefotaxime, 7 of 8 to ceftazidime and amikacin, and 4 of 7 to aztreonam; all isolates were sensitive to quinolones and imipenem. Four infants died. In all 4 of the isolates, they were sensitive only to quinolones and imipenem, and the empiric therapy used for suspected sepsis proved to be inappropriate. The outbreak was terminated by temporary closure of NICU in May 1992. Strict hand washing practices were reemphasized, and the previous empiric antibiotic protocol used for suspected sepsis (mezlocillin plus amikacin, and lately ceftazidime plus amikacin) was changed to imipenem and amikacin in the risk population. At closure, 5 additional infants had MRK in stools and/or tracheal suction specimens. Development of MRK organisms should dictate a rational use of empiric antibiotics for neonatal infections in NICU.