Outbreak of Extended Spectrum Beta Lactamase Producing Klebsiella Species Causing Neonatal Sepsis at Patan Hospital in Nepal
Introductions: Klebsiella sepsis is the most important nosocomial infection inÂ neonates. The objectives of this study were to review an outbreak in a neonatalÂ unit caused by Klebsiella species, to identify the source of the infections, andÂ to identify infection control measures for eradication and prevention of theseÂ infections.
Methods: The case notes and investigation reports of all sepsis cases admittedÂ in neonatal units of Patan hospital from July to December 2011 caused byÂ Klebsiella species were retrospectively reviewed. The demographic profile, riskÂ factors along with clinical features and management of sepsis were reviewed.
Results: Twenty three out of 37 neonatal blood cultures grew Klebsiella species.Â Thirty one were K. pneumoniae and six K. oxytoca. Seventeen of the 31 (55%)Â K. pneumoniae isolates were multidrug resistant and extended spectrum betaÂ lactamase producers. Eighteen of 23 (78%) neonates with Klebsiella sepsis died.Â After extensive cleaning methods and identifying an intermittently leaking roofÂ in one of the nurseries below a vescicovaginal fistula room of gynecologicalÂ ward above, the infection outbreak was finally controlled.
Conclusions: Infections with extended spectrum beta lactamase producingÂ Klebsiella spp. are a threat in neonatal units because of limited treatmentÂ options for these multidrug resistant organisms. Identification of the sourceÂ and control of the outbreak can be a challenge.
Keywords: extended spectrum beta lacatamase, Klebsiella, multi drug resistant,Â neonates