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  • Original Article
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RETRACTED ARTICLE: Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

Journal of Perinatology volume 28, pages 685–690 (2008)Cite this article

This article was retracted on 13 June 2023

This article has been updated

Abstract

Objectives:

Extended-spectrum beta-lactamase producing (ESBL) Klebsiella pneumoniae is an important cause of nosocomial infections in neonatal intensive care units (NICUs). Our objectives were to determine (1) the incidence of ESBL K. pneumoniae in our NICU, (2) the frequency of SHV-1 and SHV-2 gene acquisition among ESBL K. pneumoniae isolates, (3) the risk factors associated with ESBL K. pneumoniae infection and (4) the clinical outcomes of infected infants.

Study Design:

We conducted a prospective surveillance study in our NICU over a period of 1 year on all neonates admitted without evidence of early sepsis. We collected specimens from blood, urine, cerebrospinal fluid, swabs from wounds and throat and endotracheal tube aspirates of infants whenever sepsis was suspected. Bacterial isolates were identified via clinical morphology, Gram stain and standard biochemical tests. Antimicrobial susceptibility was determined by disc diffusion method, and phenotypic confirmation of ESBL production was done by the double-disc synergy test and Etest. Genetic detection of SHV-1 and SHV-2 genes in ESBL K. pneumoniae isolates was done by polymerase chain reaction (PCR) and restriction fragment length polymorphisms. Risk factors associated with ESBL K. pneumoniae infection were analysed by both univariate and multiple logistic regression methods.

Results:

A total of 980 cultures were obtained from 380 neonates, and 372 screening cultures were collected from the environment. K. pneumoniae was cultured from 27 (7%) infants (3.8/1000 patient-days); of them, 18 (67%) were ESBL producers. PCR amplicons revealed the presence of SHV-2 in all 18 isolates (100%), and SHV-1 gene in 8 isolates (44%). Independent risk factors for ESBL K. pneumoniae infection were mechanical ventilation (OR: 4.2, confidence interval (CI): 1.6–11.0); birth weight <1500 g (OR: 3.2, CI: 1.2–8.3) ); duration of hospitalization >15 days (OR: 4.1, CI: 1.2–14.4); total parenteral nutrition (OR: 4.9, CI: 1.1–21.7); and previous use of oxyimino-antibiotics (OR: 4.9, CI: 1.1–21.5). ESBL was associated with higher mortality (RR=3.1, CI: 1.04–9.1) and prolonged hospitalization in those who survived (OR=3.8 CI: 1.02–11.2). Environmental cultures (n=372) had ESBL K. pneumoniae in nine isolates: four from suction tubes, two from the incubators and three from the hands of care givers.

Conclusion:

ESBL K. pneumoniae is a significant source for mortality and morbidity in infants admitted to NICU. Use of oxyimino-antibiotics is a significant risk factor for infection. The clinical significance for the SHV-1 and SHV-2 genes should be further explored.

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References

  1. Brady MT . Health care-associated infections in the neonatal intensive care unit. Am J Infect Control 2005; 33: 268–275.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mahieu LM, Buitenweg N, Beutels P, De Dooy JJ . Additional hospital stay and charges due to hospital-acquired infections in a neonatal intensive care unit. J Hosp Infect 2001; 47: 223–229.

    Article  CAS  PubMed  Google Scholar 

  3. Boo NY, Ng SF, Lim VK . A case-control study of risk factors associated with rectal colonization of extended-spectrum beta-lactamase producing Klebsiella sp. in newborn infants. J Hosp Infect 2005; 61: 68–74.

    Article  PubMed  Google Scholar 

  4. Linkin DR, Fishman NO, Patel JB, Merrill JD, Lautenbach E . Risk factors for extended-spectrum beta-lactamase-producing Enterobacteriaceae in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2004; 25: 781–783.

    Article  PubMed  Google Scholar 

  5. Pessoa-Silva CL, Meurer Moreira B, Camara Almeida V, Flannery B, Almeida Lins MC, Mello Sampaio JL et al. Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit: risk factors for infection and colonization. J Hosp Infect 2003; 53: 198–206.

    Article  CAS  PubMed  Google Scholar 

  6. Miranda G, Castro N, Lea B, Valenzuela A, Garza-Ramos U, Rojas T et al. Clonal and horizontal dissemination of Klebsiella pneumoniae expressing SHV-5 extended-spectrum beta-lactamase in a Mexican pediatric hospital. J Clin Microbiol 2004; 42: 30–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Gastmeier P, Groneberg K, Weist K, Ruden H . A cluster of nosocomial Klebsiella pneumoniae bloodstream infections in a neonatal intensive care department: identification of transmission and intervention. Am J Infect Control 2003; 31: 424–430.

    Article  PubMed  Google Scholar 

  8. Bagattini M, Crivaro V, Di Popolo A, Gentile F, Scarcella A, Triassi M et al. Molecular epidemiology of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit. J Antimicrob Chemother 2006; 57: 979–982.

    Article  CAS  PubMed  Google Scholar 

  9. Bradford PA . Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 2001; 14: 933–951.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Al-Jasser AM . Extended-spectrum beta-lactamases (ESBLs): a global problem. Kuwait Med J 2006; 38: 171–185.

    Google Scholar 

  11. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM . CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16: 128–140.

    Article  CAS  PubMed  Google Scholar 

  12. Koneman EW, Allen SD, Janda WM, Schreckenberger RC, Winn WC . Introduction to microbiology, part II: guidelines for the collection, transport, processing, analysis and reporting of cultures from specific specimen sources. In: Koneman EW, Allen SD, Janda WM, Schreckenberger RC, Winn WC (eds). Color Atlas and Textbook of Diagnostic Microbiology, 5th edn. Lippincot-Raven: Philadelphia, 1997, pp 121–170.

    Google Scholar 

  13. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard, 9th edn. Clinical and Laboratory Standards Institute document M2-A9 (ISBN 1-56238-586-0) Clinical and Laboratory Standards Institute: Wayne, Pennsylvania, USA, 2006.

  14. Jarlier V, Nicolas MH, Fournier G, Philippon A . Extended broad-spectrum beta-lactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns. Rev Infect Dis 1988; 10: 867–878.

    Article  CAS  PubMed  Google Scholar 

  15. Chen WP, Kuo TT . A simple and rapid method for the preparation of gram-negative bacterial genomic DNA. Nucleic Acids Res 1993; 21: 2260.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Haley RW, Gaynes RP, Aber RC, Bennet JV . Surveillance of nosocomial infections. In: Bennet JV, Brachman PS (eds). Hospital Infections, 3rd edn. Little, Brown and Company: Boston, MA, 1992, pp 79–108.

    Google Scholar 

  17. Moore KL, Kainer MA, Badrawi N, Afifi S, Wasfy M, Bashir M et al. Neonatal sepsis in Egypt associated with bacterial contamination of glucose-containing intravenous fluids. Pediatr Infect Dis J 2005; 24: 590–594.

    Article  PubMed  Google Scholar 

  18. Woodford N, Dallow JW, Hill RL, Palepou MF, Pike R, Ward, ME et al. Ertapenem resistance among Klebsiella and Enterobacter submitted in the UK to a reference laboratory. Int J Antimicrob Agents 2007; 29: 456–459.

    Article  CAS  PubMed  Google Scholar 

  19. Jain A, Mondal R . Prevalence & antimicrobial resistance pattern of extended spectrum beta-lactamase producing Klebsiella spp isolated from cases of neonatal septicaemia. Indian J Med Res 2007; 125: 89–94.

    CAS  PubMed  Google Scholar 

  20. Lee K, Yong D, Choi YS, Yum JH, Kim JM, Woodford N et al. Reduced imipenem susceptibility in Klebsiella pneumoniae clinical isolates with plasmid-mediated CMY-2 and DHA-1 beta-lactamases co-mediated by porin loss. Int J Antimicrob Agents 2007; 29: 201–206.

    Article  CAS  PubMed  Google Scholar 

  21. Jacoby GA, Medeiros AA . More extended-spectrum beta-lactamases. Antimicrob Agents Chemother 1991; 35: 1697–1704.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Schmitt J, Jacobs E, Schmidt H . Molecular characterization of extended-spectrum beta-lactamases in Enterobacteriaceae from patients of two hospitals in Saxony, Germany. J Med Microbiol 2007; 56: 241–249.

    Article  CAS  PubMed  Google Scholar 

  23. Martins-Loureiro M, de Moraes BA, de Mendonca VL, Rocha-Quadra MR, dos Santos-Pinheiro G, Dutra-Asensi M . Molecular epidemiology of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolated from neonatal intensive care unit patients involved in hospital infection cases in Rio de Janeiro, Brazil. Rev Latinoam Microbiol 2001; 43: 88–95.

    CAS  PubMed  Google Scholar 

  24. Crivaro V, Bagattini M, Salza MF, Raimondi F, Rossano F, Triassi M et al. Risk factors for extended-spectrum beta-lactamase-producing Serratia marcescens and Klebsiella pneumoniae acquisition in a neonatal intensive care unit. J Hosp Infect 2007; 67: 135–141.

    Article  CAS  PubMed  Google Scholar 

  25. Kuo KC, Shen YH, Hwang KP . Clinical implications and risk factors of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infection in children: a case-control retrospective study in a medical center in southern Taiwan. J Microbiol Immunol Infect 2007; 40: 248–254.

    PubMed  Google Scholar 

  26. Huang Y, Zhuang S, Du M . Risk factors of nosocomial infection with extended-spectrum beta-lactamase-producing bacteria in a neonatal intensive care unit in China. Infection 2007; 35: 339–345.

    Article  CAS  PubMed  Google Scholar 

  27. Ntagiopoulos PG, Paramythiotou E, Antoniadou A, Giamarellou H, Karabinis A . Impact of an antibiotic restriction policy on the antibiotic resistance patterns of Gram-negative microorganisms in an Intensive Care Unit in Greece. Int J Antimicrob Agents 2007; 30: 360–365.

    Article  CAS  PubMed  Google Scholar 

  28. Boyce JM, Pittet D . Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002; 51: 1–45.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Neonatal Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt

    H Abdel-Hady

  2. Department of Medical Microbiology and Immunology, Mansoura Faculty of Medicine, Mansoura, Egypt

    S Hawas, M El-Daker & R El-Kady

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  1. H Abdel-Hady
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  2. S Hawas
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  4. R El-Kady
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Correspondence to H Abdel-Hady.

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Abdel-Hady, H., Hawas, S., El-Daker, M. et al. RETRACTED ARTICLE: Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit. J Perinatol 28, 685–690 (2008). https://doi.org/10.1038/jp.2008.73

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