The emergence of multiple resistant bacteria introduces a difficult era of intensive care medicine. Rectal colonization of neonates in an infant intensive care unit (IICU) with a multiple resistant Klebsiella pneumonias (MRKp.), resulted in severe disease, changes in routine antibiotic usage to more toxic agents, and imposed severe limitations of a vital community service unit. Colonization with MRKp. (resistant to ampicillin, carbenicillin, cephalosporins, kanamycin, gentamicin) occurred from 6/75 until 7/76. Two epidemic periods of colonization were noted with up to 16 neonates colonized and the occurrence of clinical disease, including septicemia, peritonitis and necrotizing enterocolitis. Associated with increaaed MRKp. isolation was the emergence of other organisms with identical multiple resistances.
Risk factors for colonization included 1) prior treatment with an aminoglycoside 2) the prolonged presence in the IICU of a colonized infant 3) colonization of faucets and drains.
Control measures included 1) regularly scheduled rectal swab cultures on a gentamicin containing McConkey agar 2) temporary cessation of aminoglycoside use, substituting chloratnphenicol or polymyxin H 3) cohorting colonized neonates into an isolation unit 5) elimination of the organism from environmental sources and 5) continued monitoring. These measures were successful but costly.
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Arbeter, A., Aff, C., Dill, P. et al. Experiences With A Multiple Resistant Klebsiella pneumonias In An Infant Intensive Care Unit. Pediatr Res 11, 433 (1977). https://doi.org/10.1203/00006450-197704000-00385