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LETTER TO EDITOR  
Year : 2015  |  Volume : 7  |  Issue : 4  |  Page : 173-174
Infection control care bundles prevents emergence of multidrug resistant nosocomial pathogens in newborn care units: A perspective


1 Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India
2 Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India

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Date of Web Publication25-Nov-2015
 

How to cite this article:
Ramakrishnan K, Venkatesh S, Dhandapany G, Palanisamy S. Infection control care bundles prevents emergence of multidrug resistant nosocomial pathogens in newborn care units: A perspective. J Global Infect Dis 2015;7:173-4

How to cite this URL:
Ramakrishnan K, Venkatesh S, Dhandapany G, Palanisamy S. Infection control care bundles prevents emergence of multidrug resistant nosocomial pathogens in newborn care units: A perspective. J Global Infect Dis [serial online] 2015 [cited 2019 Oct 15];7:173-4. Available from: http://www.jgid.org/text.asp?2015/7/4/173/170507


Sir,

We report an outbreak of multidrug resistant (MDR) Klebsiella pneumoniae in our neonatal intensive care unit (NICU) and the preventive measures adopted to control it.

The outbreak began with a 28-week, appropriate for gestational age baby who developed clinical features of sepsis at 48 h of life. Piperacillin-tazobactam and amikacin were started empirically, and later changed to meropenem, as Klebsiella pneumoniae was isolated in blood culture, sensitive only to meropenem. Second baby, a 33-week, small for gestational age (SGA) baby, admitted 3 days later developed MDR Klebsiella sepsis at 48 h of life. Third and fourth babies were 30-week, SGA twins admitted 10 days prior to the outbreak. Heavy growth of Klebsiella pneumoniae sensitive to piperacillin-tazobactum was isolated from the umbilical catheter tip of first twin on day 5 of life. The second twin had features suggestive of early onset sepsis and blood culture grew Klebsiella pneumoniae sensitive to piperacillin-tazobactum. Though both babies were showing signs of improvement on piperacillin-tazobactum, they had clinical deterioration 48 h after the detection of MDR Klebsiella in the index baby. Hence, meropenem was started after sending repeat blood culture in which MDR Klebsiella was isolated. The characteristics of the isolates are depicted in [Table 1]. Two out of these four babies did not survive. Following this outbreak, active surveillance was initiated. Swabs were taken from all surfaces, equipments, and water source followed by 24-h fumigation with formaldehyde. Swabs taken from the power and timer button of the warmer of the index patient showed growth of MDR Klebsiella. Subsequent strategy adopted was a set of interventions which included short fumigations at 3 months interval, reinforcing strict hand washing before and after patient care, disinfecting hands after handling equipments, contact isolation and strict barrier nursing for any baby with suspected or proven sepsis, maintaining closed vascular system for administering parental fluids, reinforcing strict aseptic and judicious catheter insertion practices, daily environmental cleaning with 1:100 sodium hypochlorite solution, policy restriction on empirical use of third generation cephalosporin, and periodic surveillance. In the subsequent 7 months there were no reports of MDR Klebsiella, and also the incidence of culture positive sepsis among the neonates decreased from 8% during the pre-intervention period to 4% during the post-intervention 7 months period (P = 0.027).
Table 1: Characterization of Klebsiella pneumoniae isolated during the outbreak


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Emergence of mutated extended-spectrum β-lactamase (ESBL) producers associated with indiscriminate use of beta-lactam antibiotics containing oxyimino group [1],[2] are being increasingly reported. These ESBL producers colonize the hands of healthcare personnel and lead to spread of infection. [3] Carbapenems were the main class of drugs used in combating ESBL producers. But organisms resistant to carbapenems have emerged, notably Klebsiella pneumoniae carbapenemase (KPC). [4],[5] In our case series, AmpC-type beta-lactamase was detected in all isolates; the striking absence of ESBL on phenotypic confirmation could be due to the presence of AmpC-type beta-lactamase, [1] which resist inhibition by clavulanate. Polymerase chain reaction (PCR) and deoxyribonucleic acid (DNA) sequencing were unavailable to confirm the presence of ESBL/KPC activity. This article emphasizes importance of a "bundle" approach of preventive interventions in containing outbreaks with MDR organisms.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Dhillon RH, Clark J. ESBLs: A clear and present danger? Crit Care Res Pract 2012;2012:625170.  Back to cited text no. 1
    
2.
Paterson DL, Ko WC, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, et al. International prospective study of Klebsiella pneumoniae bactereremia: Implications of extended-spectrum β-lactamase production in nosocomial infections. Ann Intern Med 2004;140:26-32.  Back to cited text no. 2
    
3.
Coulter C, Faogali JC, Doige S, Bodman J, George N. Hand culture surveillance to investigate transmission of epidemic extended-spectrum β-lactamase producing klebsiella pneumonia in a major intensive care unit. Austr NZ J Med 1995;25:572.  Back to cited text no. 3
    
4.
Falagas ME, Lourida P, Poulikakos P, Rafailidis PI, Tansarli GS. Antibiotic treatment of infections due to carbapenem-resistant enterobacteriaceae: Systemic evaluation of available evidence. Antimicrob Agents Chemother 2014;58:2654-63.  Back to cited text no. 4
    
5.
Chakkarapani AA, Amboiram P, Balakrishnan U, Ninan B, Sekar U. Pattern and antimicrobial susceptibility of carbapenem resistant organisms in tertiary care neonatal intensive care unit, India. J Clin Neonatol 2014;3:200-4.  Back to cited text no. 5
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Correspondence Address:
Soma Venkatesh
Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.170507

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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
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