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Klebsiella pneumoniae Bloodstream Infections Among Neonates in a High-Risk Nursery in Cali, Colombia

Published online by Cambridge University Press:  02 January 2015

Chesley Richards ,
Juan Alonso-Echanove ,
Yolanda Caicedo  and
William R. Jarvis
Chesley Richards*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Atlanta, Georgia Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Juan Alonso-Echanove
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Atlanta, Georgia Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Yolanda Caicedo
Affiliation:
Hospital Universitario Del Valle, Cali, Colombia
William R. Jarvis
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Atlanta, Georgia
*
Centers for Disease Control and Prevention, Mailstop E-55, 1600 Clifton Road, Atlanta, GA 30333
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Abstract

Objectives:

To determine the cause of an outbreak of Klebsiella pneumoniae bloodstream infections (BSIs) among neonates in a high-risk nursery and to institute control measures.

Design:

During the on-site investigation, a cohort study to identify risk factors for K. pneumoniae BSI, a point-prevalence study to assess K. pneumoniae colonization, a maternal cohort study to determine maternal K. pneumoniae colonization, and an observational study to evaluate healthcare worker (HCW) compliance with infection control practices were conducted.

Patients And Setting:

Neonates in a 40-bed high-risk nursery in a 700-bed university hospital in Cali, Colombia.

Intervention:

Cohorting of neonates colonized with K. pneumoniae.

Results:

The overall K. pneumoniae BSI attack rate was 10 of 105 (9.5%). In the retrospective cohort study, the number of blood transfusions (OR, 3.1 per transfusion; P = .02; CI95,1.4–9.7) and intravenous injections (OR, 1.2 per injection; P = .04; CI95, 1.0–1.5) were independently associated with K. pneumoniae BSI. The overall prevalence of K. pneumoniae colonization was 61% among neonates and 7% among mothers. During the HCW assessment, suboptimal intravenous therapy practices were observed. A cohorting intervention resulted in a significant reduction in K. pneumoniae colonization (12% vs 61%; RR, 0.19; P < .001). During the intervention period, no K. pneumoniae BSIs occurred.

Conclusions:

This investigation suggested that the outbreak probably occurred due to widespread colonization and suboptimal infection control and intravenous therapy practices. Cohorting successfully reduced the overall prevalence of K. pneumoniae colonization and, along with improved infection control practices, probably prevented K. pneumoniae BSIs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 3 , March 2004 , pp. 221 - 225
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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