ABSTRACT
From November 1991 through April 1992, 8 infants developed systemic infections due
to antibiotic multiple resistant Klebsiella (MRK). All were premature and 6 of the 8 weighed less than 1100 g; 7 of the 8 had
received previous antibiotic therapy. Five infections occurred during the first week
of life. MRK were isolated from blood (8 cases), tracheal secretions (TS-6), stool
(3), and CSF (1). All Klebsiella blood isolates were resistant to ampicillin, mezlocillin, and cefotaxime, 7 of 8
to ceftazidime and amikacin, and 4 of 7 to aztreonam; all isolates were sensitive
to quinolones and imipenem. Four infants died. In all 4 of the isolates, they were
sensitive only to quinolones and imipenem, and the empiric therapy used for suspected
sepsis proved to be inappropriate. The outbreak was terminated by temporary closure
of NICU in May 1992. Strict hand washing practices were reemphasized, and the previous
empiric antibiotic protocol used for suspected sepsis (mezlocillin plus amikacin,
and lately ceftazidime plus amikacin) was changed to imipenem and amikacin in the
risk population. At closure, 5 additional infants had MRK in stools and/or tracheal
suction specimens. Development of MRK organisms should dictate a rational use of empiric
antibiotics for neonatal infections in NICU.
Keywords
Antibiotic multiresistant Klebsiella
- systemic infections - antibiotic therapy
