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- Title
First outbreak of extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a Norwegian neonatal intensive care unit; associated with contaminated breast milk and resolved by strict cohorting.
- Authors
Rettedal, Siren; Löhr, Iren H.; Natås, Olav; Giske, Christian G.; Sundsfjord, Arnfinn; Øymar, Knut
- Abstract
Neonatal intensive care units ( NICUs) are vulnerable to nosocomial outbreaks caused by multiresistant Enterobacteriaceae, but no reports of NICU outbreaks of extended-spectrum β-lactamase ( ESBL) producing Klebsiella pneumoniae have previously been published from countries with a low level of antimicrobial resistance such as the Scandinavian countries. We describe a clonal outbreak of CTX- M-15 -producing Klebsiella pneumoniae affecting 58 infants in the neonatal intensive care unit at Stavanger University Hospital, Norway, during a period of 4 months, 2008-2009. The clone spread widely and rapidly in the NICU, and extensive interventions were required to terminate the outbreak. In contrast to previous outbreaks, only one infant acquired a systemic infection caused by the outbreak strain, probably due to a favourable epidemic strain lacking the most common virulence factors. A probable index case was identified, due to multiple positive breast milk samples collected from the infant's mother before and after the infant's transfer from another hospital. Breast milk samples from 3/18 (17%) mothers of colonized infants were positive for ESBL-producing K. pneumoniae. Vertical transmission of ESBL-producing bacteria has been shown previously,but the possibility of transmission of ESBL-producing K. pneumoniae through expressed breast milk is reported here for the first time. The increasing occurrence of ESBL-producing Enterobacteriaceae should therefore encourage changes in diagnostic routines for bacterial screening of breast milk.
- Subjects
KLEBSIELLA pneumoniae; NEONATAL intensive care; ENTEROBACTERIACEAE; BREAST milk; BETA lactamases
- Publication
APMIS, 2012, Vol 120, Issue 8, p612
- ISSN
0903-4641
- Publication type
Article
- DOI
10.1111/j.1600-0463.2012.02879.x