Epidemiological study of klebsiella infection in the special care baby unit of a London hospital

Journal of Clinical Pathology - Tập 33 Số 4 - Trang 400-407 - 1980
Eve C. Riser1, Paul Noone1, F M Howard1
1Departments of Medical Microbiology and Paediatrics, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK

Tóm tắt

Of the babies admitted to the Special Care Baby Unit of the Royal Free Hospital over 20 months, 10·2% were infected or colonised by klebsiella. The fluorescent antibody technique was used to identify epidemics caused by three strains: capsular type 8K. aerogenes,type 68K. oxytoca,or type 13K. aerogenes,each of which was predominant at a different time, exhibited a difference in virulence, and showed a predilection for different sites of infection. Intestinal colonisation was frequently followed by the presence of sepsis in other sites by the same capsular type. Antibiotic administration led to a higher incidence of klebsiella infection, while the widespread use of compounds containing hexachlorophane could have contributed to skin colonisation and infection by klebsiella. An environmental survey indicated that 1% Hycolin failed to disinfect the incubators, that the babies were the reservoirs of the organisms, and that transmission was due to inadequate hand-washing of nurses and mothers. The mothers were found to have been uninformed of hygienic techniques. They were observed in various practices which could have contributed to the spread of the organism, including contaminating communal areas and handling babies other than their own. It has been recommended that the mothers of premature infants be instructed in the hygienic measures required in dealing with this susceptible population and that the nursing and medical staff be more strict in their own observance of these procedures.

Từ khóa


Tài liệu tham khảo

Adler, J. L., Shulman, J. A., Terry, P. M., Feldman, D. B., and Skaliy, P. (1970). Nosocomial colonization with kanamycin-resistant Klebsiella pneumoniae, types 2 and 11, in a premature nursery. Journal of Pediatrics, 77, 376-385.

Barter, R. A., and Hudson, J. A. (1974). Bacteriological findings in perinatal pneumonia. Pathology, 6, 223-230.

Bettelheim, K. A., and Lennox-King, S. M. J. (1976). The acquisition of Escherichia coli by new-born babies. Infection, 4, 174-179.

Casewell, M. W., Webster, M., Dalton, M. T., and Phillips, I. (1977). Gentamicin-resistant Klebsiella aerogenes in a urological ward. Lancet, 2, 444-446.

Cichon, M. J., Craig, C. P., Sargent, J., and Brauner, L. (1977). Nosocomial Klebsiella infections in an intensive care nursery. Southern Medical Journal, 70, 33-35.

Cooke, E. M., Ewins, S., and Shooter, R. A. (1969). Changing faecal population of Escherichia coli in hospital medical patients. British Medical Journal, 4, 593-595.

Cowan, S. T. ed. (1974). Cowan and Steel's Manual for the Identification of Medical Bacteria, 2nd edition. Cambridge University Press, London.

Davies, P. A. (1971). Bacterial infection in the fetus and newborn. Archives of Disease in Childhood, 46, 1-27.

Dixon, R. E. (1975). Techniques for prevention of nosocomial surgical infections (Letter). Journal of the American Medical Association, 231, 1290.

Eickhoff, T. C. (1970). Microbiological sampling. Hospitals, 44, (8) 86-87.

Finland, M. (1972). Changing patterns of susceptibility of common bacterial pathogens to antimicrobial agents. Annals of Internal Medicine, 76, 1009-1036.

Forfar, J. 0., Gould, J. C., and Maccabe, A. F. (1968). Effect of hexachlorophane on incidence of staphylococcal and Gram negative infection in the newborn. Lancet, 2, 177-180.

Gehlbach, S. H., Gutman, L. T., Wilfert, C. M., Brumley, G. W., and Katz, S. L. (1975). Recurrence of skin disease in a nursery: ineffectuality of hexachlorophene bathing. Pediatrics, 55, 422-424.

Hable, K. A., Matsen, J. M., Wheeler, D. J., Hunt, C. E., and Quie, P. G. (1972). Klebsiella type 33 septicemnia in an infant intensive care unit. Journal of Pediatrics, 80, 920-924.

Hewitt, W. L., and Sanford, J. P. (1974). Workshop on hospital-associated infections. Journal of Infectious Diseases, 130, 680-686.

Howard, F. M., Flynn, D. M., Bradley J. M., Noone, P., and Szawatkowski, M. (1977). An outbreak of necrotising enterocolitis caused by Clostridium butyriicum. Lancet, 2, 1099-1102.

Kelsey, J. C. (1975). Hygiene of babies' incubators. (Letter). Lancet, 1 (7904), 455-456.

Kelsey, J. C., and Maurer, I. M. (1966). An in-use test for hospital disinfectants. Monthly Bulletin of the Ministry of Health and Public Health Laboratory Service, 25, 180-184.

Knittle, M. A., Eitzman, D. V., and Baer, H. (1975).

Role of hand contamination of personnel in the epidemiology of Gram-negative nosocomial infections. Journal ofPediatrics, 86, 433-437.

Ludescher, E., Breitfellner, G., and Troy, E. (1976). Klinisch und epidemiologisch ungewohnliche Infection mit E. coli 0111: B4 auf einer Neugeborenenabteilung. Padiatrie und Padologie, 11, 428-434.

Marples, R. R. (1975). Ecology of diseased skin. Journal of Medical Microbiology, 8, p i-ii (Abstract).

O'Farrell, S. M., Lennox-King, S. M. J., Bettelheim, K.A., Shaw, E. J., and Shooter, R. A. (1976). Escherichia coli in a maternity ward. Infection, 4, 146-152.

Pierog, S., Nigam, S., Lala, R. V., Crichlow, D. K., and Evans, H. E. (1977). Neonatal septicemia due to Klebsiella pneumoniae type 60. Epidemic of unusually low virulence. New York State Journal ofMedicine, 77, 737-741.

Riser, E., Noone, P., and Poulton, T. A. (1976). A new serotyping method for Klebsiella species: development of the technique. Journal of Clinical Pathology, 29, 296-304.

Riser, E., Noone, P., and Thompson, R. E. M. (1978). The use of a fluorescence typing method in an epidemiological study of Klebsiella infection in a London hospital. Journal of Hygiene, Cambridge, 80, 43-56.

Schimpff, S. C., Miller, R. M., Polakavetz, S., and Hornick, R. B. (1974). Infection in the severely traumatized patient. Annals ofSurgery, 179, 352-357.

Selden, R., Lee, S., Wang, W. L. L., Bennett, J. V., and Eickhoff, T. C. (1971). Nosocomial Klebsiella infections: intestinal colonization as a reservoir. Annals of Internal Medicine, 74, 657-664.

Shinebaum, R., Cooke, E. M., and Brayson, J. C. (1979). Acquisition of Klebsiella aerogenes by neonates. Journal of Medical Microbiology, 12, 201-205.

Shooter, R. A., Faiers, M. C., Cooke, E. M., Breaden, A. L., and O'Farrell, S. M. (1971). Isolation of Escherichia coli, Pseudomonas aeruginosa and Klebsiella from food in hospitals, canteens, and schools. Lancet, 2, 390-392.

Stratford, B. C. (1963). The investigation and treatment of recurrent superficial staphylococcal infection. Medical Journal of Australia, 1, 308-312.

Terman, J. W., Alford, R. H., and Bryant, R. E. (1972). Hospital-acquired Klebsiella bacteremia. American Journal of the Medical Sciences, 264, 191-196.

Thông tin
Thông tin xuất bản

Journal of Clinical Pathology

Tập 33 Số 4

400-407

Thông tin tác giả