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Nosocomial Klebsiella Infection in a Neonatal Unit: Identification of Risk Factors for Gastrointestinal Colonization

Published online by Cambridge University Press:  02 January 2015

C. Glen Mayhall ,
V. Archer Lamb ,
Cynthia M. Bitar ,
Kathy B. Miller ,
Elisabeth Y. Furse ,
Barry V. Kirkpatrick ,
Sheldon M. Markowitz ,
James M. Veazey Jr.  and
Francis L. Macrina
C. Glen Mayhall*
Affiliation:
Hospital Epidemiology Unit, Division of Infectious Diseases, Department of Medicine, Section of Neonatology, Department of Pediatrics and Department of Microbiology, Medical College of Virginia, Virginia Commonwealth University, and the Medical College of Virginia Hospitals, Richmond, Virginia
V. Archer Lamb
Affiliation:
Hospital Epidemiology Unit, Division of Infectious Diseases, Department of Medicine, Section of Neonatology, Department of Pediatrics and Department of Microbiology, Medical College of Virginia, Virginia Commonwealth University, and the Medical College of Virginia Hospitals, Richmond, Virginia
Cynthia M. Bitar
Affiliation:
Hospital Epidemiology Unit, Division of Infectious Diseases, Department of Medicine, Section of Neonatology, Department of Pediatrics and Department of Microbiology, Medical College of Virginia, Virginia Commonwealth University, and the Medical College of Virginia Hospitals, Richmond, Virginia
Kathy B. Miller
Affiliation:
Hospital Epidemiology Unit, Division of Infectious Diseases, Department of Medicine, Section of Neonatology, Department of Pediatrics and Department of Microbiology, Medical College of Virginia, Virginia Commonwealth University, and the Medical College of Virginia Hospitals, Richmond, Virginia
Elisabeth Y. Furse
Affiliation:
Hospital Epidemiology Unit, Division of Infectious Diseases, Department of Medicine, Section of Neonatology, Department of Pediatrics and Department of Microbiology, Medical College of Virginia, Virginia Commonwealth University, and the Medical College of Virginia Hospitals, Richmond, Virginia
Barry V. Kirkpatrick
Affiliation:
Hospital Epidemiology Unit, Division of Infectious Diseases, Department of Medicine, Section of Neonatology, Department of Pediatrics and Department of Microbiology, Medical College of Virginia, Virginia Commonwealth University, and the Medical College of Virginia Hospitals, Richmond, Virginia
Sheldon M. Markowitz
Affiliation:
Hospital Epidemiology Unit, Division of Infectious Diseases, Department of Medicine, Section of Neonatology, Department of Pediatrics and Department of Microbiology, Medical College of Virginia, Virginia Commonwealth University, and the Medical College of Virginia Hospitals, Richmond, Virginia
James M. Veazey Jr.
Affiliation:
Hospital Epidemiology Unit, Division of Infectious Diseases, Department of Medicine, Section of Neonatology, Department of Pediatrics and Department of Microbiology, Medical College of Virginia, Virginia Commonwealth University, and the Medical College of Virginia Hospitals, Richmond, Virginia
Francis L. Macrina
Affiliation:
Hospital Epidemiology Unit, Division of Infectious Diseases, Department of Medicine, Section of Neonatology, Department of Pediatrics and Department of Microbiology, Medical College of Virginia, Virginia Commonwealth University, and the Medical College of Virginia Hospitals, Richmond, Virginia
*
Division of Infectious Diseases, Medical College of Virginia, MCV Station, Box 49, Richmond, VA 23298
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Abstract

Sequential outbreaks of infection due to gentamicin-resistant Klebsiella pneumoniae (GRKP) types 30 and 19 occurred in the neonatal intensive care unit (NICU) at the Medical College of Virginia in 1977 and 1978. The extensive epidemiologic investigation carried out included a case-control study, careful review of aseptic technique, and cultures from nursery staff and environment. The gastrointestinal (GI) tracts of the patients were the reservoirs for GRKP, and the epidemic strain was transmitted by hands of personnel. The case-control study showed a significant relationship between acquisition of GRKP by patients and oropharyngeal and GI instrumentation, including use of bag resuscitation, oropharyngeal suctioning, and use of nasogastric feeding tubes. The findings of the case-control study were supported by observation of the patient care techniques practiced by NICU staff. Institution of control measures based on results of the epidemiologic investigation of the first outbreak rapidly brought the second outbreak under control, even though cohorting or use of routine isolation was not possible. Whereas GI colonization and hand transmission have been described previously in outbreaks of K. pneumoniae infections in NICUs, this study is the first to document the mode of inoculation of patients' GI tracts by contaminated hands of personnel.

Type
Research Article
Information
Infection Control & Hospital Epidemiology , Volume 1 , Issue 4 , August 1980 , pp. 239 - 246
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1980

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