Septic arthritis in neonates due to extended spectrum beta-lactamase producing Klebsiella pneumoniae - Outbreak analysis and long term follow-up
AbstractBetween May and June 2002, we recorded and outbreak of Septic Arthritis in neonates due to Extended Spectrum Beta-Lactamase producing Klebsiella pneumoniae at our neonatal intensive care unit. The confirmed cases were then followed up to look for long term morbidities associated with the infection. We analyzed the microbiological and epidemiological features of the outbreak and the various measures implemented to ward off the same. We also studied the long term morbidities associated with nosocomial infection. All neonates admitted to the NICU during this period were screened and those with clinico-microbiological evidence of septic arthritis were included in the study. Microbiological screening of the environment, personnel, patients and their attendants were conducted and 85 different environmental sites were sampled. Six neonates were confirmed to have septic arthritis after an average NICU stay of 10.00±3.16 days. Culture of synovial fluid grew K. pneumoniae. All isolates had similar biochemical and antibiotic resistance pattern suggestive of clonality of infection. Plasmid analysis of these samples revealed a single plasmid (35.8MD) in all the isolates. Similar K. pneumoniae strain with the same plasmid was isolated from the water samples which was stored and used for hand washing. During the nine year follow up period, three neonates recovered completely, one developed dislocation of the joint and two were lost to follow up. Our study demonstrates the need for a comprehensive infection control measure and intensive monitoring of the NICUs for the ESBL producing K. pneumoniae.
Copyright conditions: Copyright on any research article in the International Journal of Infection Control (IJIC) is retained by the author(s). Authors grant IJIC permission to publish the article and identify itself as the original publisher. Authors also grant any third party the right to use the article freely as long as its integrity is maintained and its original authors, citation details and publisher are identified. IJIC conforms to the Creative Commons Attribution License (http://creativecommons.org) as terms and conditions of publishing research articles. In summary, anyone is free: • to copy, distribute, and display the work; • to make derivative works; • to make commercial use of the work; as long as: • the original author must be given credit; • for any reuse or distribution, it must be made clear to others what the license terms of this work are; • any of these conditions can be waived if the authors gives permission. Statutory fair use and other rights are in no way affected by the above. Authors' certification: In submitting a manuscript to IJIC, authors are requested to certify that: • They are authorized by their co-authors to enter into these arrangements. • They warrant, on behalf of themselves and their co-authors, that: o the article is original, has not been formally published in any other peer-reviewed journal, is not under consideration by any other journal and does not infringe any existing copyright or any other third party rights; o they are the sole author(s) of the article and have full authority to enter into this agreement and in granting rights to IJIC are not in breach of any other obligation. If the law requires that the article be published in the public domain, they will notify IJIC at the time of submission; o the article contains nothing that is unlawful, libellous, or which would, if published, constitute a breach of contract or of confidence or of commitment given to secrecy; o they have taken due care to ensure the integrity of the article.