Analysıs of Three Outbreaks Due to Klebsıella Specıes in a Neonatal Intensıve Care Unıt

ABSTRACT patients died. The isolates tested were completely susceptible to meropenem, cefoxitin, and ciprofloxacin and were resistant to cephalothin. More than half of these strains were resistant to many beta-lactam antibiotics, amikacin, and trimethoprim/suk farmethoxazole. Typing procedures yieided 3 antibiotypes and 3 genotypes among the isolates of the first outbreak, 3 antibio- types with i subtype. and 2 genntypes with I subtype in the sec ond outbreak, and 2 antibiotypes and 2 genotypes in the thircd outbreak. CONCLUSIONS: Klebsiella outbreaks mainly affected premature neonates with intravenous catheters, mechanical ven tilation, or both. The high inortality rate (76.7%) was notable Resistance to multiple antibiotics, but mainly to broad spectrum beta-lactam antibiotics, was observed, particularty in K pmezmo niae isolates, Malecular typing indicated that the three autbreaks were aot related 2003:24:495-500). OBJECTIVE: To investigate the clinical, microbiological, and epidemiologic features of three outbreaks caused by Klebsiella during 3 years. SETTING: Neonatal intensive care unit of a university hospital PATIENTS: Thirty affected neonates. METHODS: Data were collected through chart reviews and conversations with physicians. Screening samples were obtained from the staff, the neonates, and the environment. Antibiogram typing and arbitrarily primed polymerase chaln reaction-based fingerprinting were used to type the strains, RESULTS: The first outbreaNhad 13 K. pneumonice strains isolated The second outbreakNad 1O K. azytoca strains isolated. The third outbreak had 20 K. pneumonioe strains iso- lated. More than half of the patients had low birth weights, were premature, and underwent mechanical ventilation and intra- venous cathetierization.