Successful control of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae ST307 outbreak in a neonatal intensive care unit
Successful control of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae ST307 outbreak in a neonatal intensive care unit
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DOI：
10.1186/s12879-020-4889-z
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发表时间：
2020-02-22
影响因子：
3.7
通讯作者：
Hwang, Inyeong
中科院分区：
文献类型：
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作者：
Baek, Eun-Hwa;Kim, Se-Eun;Hwang, Inyeong
背景在这项研究中，我们评估了 2017 年 8 月新生儿重症监护病房 (NICU) 爆发的产超广谱 β-内酰胺酶肺炎克雷伯菌 (ESBL-KPN) 分离株的遗传相关性，我们采取了积极的对策，成功控制了这次疫情。方法在 2018 年 1 月开始加强感染控制 (IC) 实践之前和之后评估了与医疗保健相关的 ESBL-KPN 菌血症的发生率。为新生儿、医务人员和 NICU 环境设置并进行监测。对分离的 KPN 菌株进行了分子分析，包括脉冲场凝胶电泳 (PFGE)、序列分型和 ESBL 基因分型。 结果实施增强型 IC 程序后，医疗保健相关菌血症发生率从每 1000 个患者日 6.0 例降至 0.0 例。 2017 年 12 月的监测培养中，来自新生儿 (n=11/15, 73.3%)、医务人员 (n=1/41, 2.4%) 以及医疗设备和环境 (6/181, 3.3%) 的样本检测出 ESBL-KPN 呈阳性。主动监测培养显示，在 1 月至 1 月至 20 年间，接受筛查的 72 名新生儿中，有 23 名 (31.9%) 定植了 ESBL-KPN。 2018年3月，所有分离株均表现出密切相关的PFGE模式，并被鉴定为携带CTX-M-15基因的ST307菌株。结论受污染的NICU环境和医疗设备以及医务人员的传播似乎是ESBL-KPN感染暴发的源头。 2018年1月至3月，我们采用强化IC策略，成功控制了CTX-M-15阳性KPN的克隆爆发。 ST307 已成为 NICU 中重要的菌血症病原体，应仔细监测。
BackgroundIn this study, we evaluated the genetic relatedness of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KPN) isolates from an outbreak in a neonatal intensive care unit (NICU) in August 2017, We implemented an active countermeasure to control this outbreak successfully.MethodsThe incidence of healthcare-associated ESBL-KPN bacteremia was evaluated before and after initiating enhanced infection control (IC) practices in January 2018. Surveillance cultures were set up and monitored for neonates, medical personnel, and NICU environments. Molecular analyses, including pulse-field gel electrophoresis (PFGE), sequence typing, and ESBL genotyping, were performed for the isolated KPN strains.ResultsAfter implementing the enhanced IC procedures, the healthcare-associated bacteremia rate decreased from 6.0 to 0.0 per 1000 patient-days. Samples from neonates (n=11/15, 73.3%), medical personnel (n=1/41, 2.4%), and medical devices and the environments (6/181, 3.3%) tested positive for ESBL-KPN in the surveillance cultures in December 2017. Active surveillance cultures revealed that 23 of 72 neonates who were screened (31.9%) were colonized with ESBL-KPN between January and March 2018. All the isolates demonstrated closely related PFGE patterns and were identified as ST307 strain carrying the CTX-M-15 gene.ConclusionsContaminated NICU environments and medical devices, as well as transmission by medical personnel, appeared to be the source of the outbreak of ESBL-KPN infection. We employed an enhanced IC strategy during January-March 2018 and successfully controlled the clonal outbreak of CTX-M-15-positive KPN. ST307 has emerged as an important bacteremia-causing pathogen in the NICU and should be carefully monitored.