Characterization of an outbreak due to extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a pediatric intensive care unit transplant population

Jill A. Rebuck, Keith M. Olsen, Paul D Fey, Alan Norman Langnas, Mark Edmund Rupp

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53 Citations (Scopus)

Abstract

Limited information exists regarding Klebsiella pneumoniae's production of an extended-spectrum β-lactamase (KP-ESBL) in pediatric patients, particularly solid-organ transplant recipients. This study characterized the microbiological, epidemiological, and clinical features of a KP-ESBL outbreak in children receiving a liver transplant, an intestinal transplant, or both. All children found to have microbiologically confirmed K. pneumoniae during a 21-month period were reviewed. ESBL production was defined by double-disk diffusion, and 6 distinct pulsed-field gel electrophoresis patterns were identified. Fifty-six percent of the transplant patients we studied developed KP-ESBL, representing 87% of all microbiologically confirmed cases at our institution. As compared with 16 control transplant patients who were negative for KP-ESBL, the 20 transplant patients who acquired KP-ESBL were younger (aged ≤5 years; 80.0% vs. 43.8%, P = .038) and experienced placement of ≥3 central venous catheters before recovery of the first K. pneumoniae isolate (73.7% vs. 18.8%, P = .002). This study suggests that children who receive liver or intestinal transplants are at high risk for KP-ESBL acquisition.

Original languageEnglish (US)
Pages (from-to)1368-1372
Number of pages5
JournalClinical Infectious Diseases
Volume31
Issue number6
DOIs
StatePublished - Jan 1 2000

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Pediatric Intensive Care Units
Klebsiella pneumoniae
Disease Outbreaks
Transplants
Population
Central Venous Catheters
Pulsed Field Gel Electrophoresis
Liver
Pediatrics

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

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title = "Characterization of an outbreak due to extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a pediatric intensive care unit transplant population",
abstract = "Limited information exists regarding Klebsiella pneumoniae's production of an extended-spectrum β-lactamase (KP-ESBL) in pediatric patients, particularly solid-organ transplant recipients. This study characterized the microbiological, epidemiological, and clinical features of a KP-ESBL outbreak in children receiving a liver transplant, an intestinal transplant, or both. All children found to have microbiologically confirmed K. pneumoniae during a 21-month period were reviewed. ESBL production was defined by double-disk diffusion, and 6 distinct pulsed-field gel electrophoresis patterns were identified. Fifty-six percent of the transplant patients we studied developed KP-ESBL, representing 87{\%} of all microbiologically confirmed cases at our institution. As compared with 16 control transplant patients who were negative for KP-ESBL, the 20 transplant patients who acquired KP-ESBL were younger (aged ≤5 years; 80.0{\%} vs. 43.8{\%}, P = .038) and experienced placement of ≥3 central venous catheters before recovery of the first K. pneumoniae isolate (73.7{\%} vs. 18.8{\%}, P = .002). This study suggests that children who receive liver or intestinal transplants are at high risk for KP-ESBL acquisition.",
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AU - Rupp, Mark Edmund

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AB - Limited information exists regarding Klebsiella pneumoniae's production of an extended-spectrum β-lactamase (KP-ESBL) in pediatric patients, particularly solid-organ transplant recipients. This study characterized the microbiological, epidemiological, and clinical features of a KP-ESBL outbreak in children receiving a liver transplant, an intestinal transplant, or both. All children found to have microbiologically confirmed K. pneumoniae during a 21-month period were reviewed. ESBL production was defined by double-disk diffusion, and 6 distinct pulsed-field gel electrophoresis patterns were identified. Fifty-six percent of the transplant patients we studied developed KP-ESBL, representing 87% of all microbiologically confirmed cases at our institution. As compared with 16 control transplant patients who were negative for KP-ESBL, the 20 transplant patients who acquired KP-ESBL were younger (aged ≤5 years; 80.0% vs. 43.8%, P = .038) and experienced placement of ≥3 central venous catheters before recovery of the first K. pneumoniae isolate (73.7% vs. 18.8%, P = .002). This study suggests that children who receive liver or intestinal transplants are at high risk for KP-ESBL acquisition.

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