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Extended‐spectrum β‐lactamase‐producing Klebsiella pneumoniae in paediatric wards: A nested case‐control study
Author(s) -
Demir Serap,
Soysal Ahmet,
Bakir Mustafa,
Kaufmann Mary E.,
Yagci Aysegul
Publication year - 2008
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/j.1440-1754.2008.01326.x
Subject(s) - medicine , odds ratio , colonisation , carriage , klebsiella pneumoniae , infection control , nested case control study , logistic regression , prospective cohort study , microbiology and biotechnology , surgery , colonization , pathology , biology , biochemistry , chemistry , escherichia coli , gene
Aim: A high rate (48.6%) of extended spectrum beta‐lactamase production among Klebsiella pneumoniae (ESBL‐KP) clinical isolates in the paediatric wards of our hospital prompted the introduction of enhanced infection control measures, and after the implementation of these measures, we instituted a prospective surveillance programme, with a nested case‐control study to determine the risk factors for rectal colonisation by ESBL‐KP. Methods: Over a 1‐year period, rectal swabs from patients and samples from the environment and the hands of health‐care workers were cultured. Strain typing of ESBL‐KP isolates was performed using pulsed‐field gel electrophoresis. Characteristics of patients who were colonised with ESBL‐KP during hospital stay were compared with those of patients who remained negative for ESBL‐KP. Multivariate analysis was performed with model‐building using stepwise logistic regression to determine independent risk factors for ESBL‐KP acquisition. Results: Forty (18.5%) of 216 patients became colonised with ESBL‐KP. The strongest independent predictors of ESBL‐KP colonisation were mechanical ventilation (odds ratio (OR): 4.28) and hospitalisation for longer than 14 days (OR: 6.97). Genotyping of the isolates indicated probable patient‐to‐patient transmission; however, we could not determine the route of this spread. During the study period, a 1.6% rate of ESBL‐KP clinical infection per 500 patient admissions was observed, in contrast to a 7% rate in the previous year. Conclusions: Prolonged length of stay and mechanical ventilation were independent predictors of ESBL‐KP colonisation. Enhanced infection control measures, antimicrobial stewardship and screening for rectal carriage were associated with a substantial decrease in paediatric units.