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Klebsiella Pneumoniae Bloodstream Infections in Neonates in a Hospital in the Kingdom of Saudi Arabia

Published online by Cambridge University Press:  02 January 2015

Ayman Abdulaziz Al-Rabea ,
Dale R. Burwen ,
Mariam A. Fath Eldeen ,
Robert E. Fontaine ,
Fred Tenover  and
William R. Jarvis
Ayman Abdulaziz Al-Rabea
Affiliation:
The Field Epidemiology Training Program, Ministry of Health, Kingdom of Saudi Arabia
Dale R. Burwen
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
Mariam A. Fath Eldeen
Affiliation:
Maternity and Children's Hospital, Riyadh, Kingdom of Saudi Arabia
Robert E. Fontaine
Affiliation:
The Field Epidemiology Training Program, Ministry of Health, Kingdom of Saudi Arabia
Fred Tenover
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
William R. Jarvis*
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
*
Hospital Infections Program, Centers for Disease Control and Prevention, Mailstop E69, 1600 Clifton Rd NE, Atlanta, GA 30333
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Abstract

Objective:

To identify risk factors for Klebsiella pneumoniae bloodstream infections (BSI) in neonates in a hospital in the Kingdom of Saudi Arabia (KSA).

Design:

Two case-control studies among hospitalized neonates during February 15-May 14, 1991, and a procedural and microbiological investigation.

Setting:

Hospital A, a maternity and children's hospital in KSA.

Patients:

Case patients had a blood culture positive for K pneumoniae after >2 days of hospitalization and had no evidence of a nonblood primary site of infection.

Results:

When the 20 case patients were compared with controls, hospitalization in a critical-care unit (odds ratio [OR], 5.5; 95% confidence interval [CI95], 1.20-51.1; P=.03) was identified as a risk factor. When the case patients were compared with a second set of controls matched by critical-care status, receipt of a particular intravenous fluid (D10%/0.2NS; OR, 11.0; CI95, 1.42-85.2; P=.009) or a blood product (OR undefined; P=.04) were identified as risk factors. Infusates were administered via umbilical catheters for most case and control patients (19/20 vs 15/20, P>.05); catheters were manipulated more frequently in patients in criticalcare units. Umbilical catheter tip, skin, or mucus membrane K pneumoniae colonization occurred in 47% and 53% of evaluated case and control patients, respectively. Available K pneumoniae isolates from blood cultures and colonization sites had identical antimicrobial susceptibility patterns. Emphasis on handwashing, careful preparation and administration of infusates, and aseptic technique for catheter insertion, maintenance, and manipulation was temporally associated with resolution of the epidemic.

Conclusions:

This outbreak was probably due to infusion therapy practices that led to BSI in nursery patients colonized with K pneumoniae. Both catheter-related infections and extrinsic contamination of infusates may have occurred. Hospital personnel should be aware of their potential to spread nosocomial pathogens from person to person and should implement Centers for Disease Control and Prevention recommendations to decrease nosocomial BSIs.

Type
Research Article
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 9 , September 1998 , pp. 674 - 679
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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