Hernández-Delgado L, Carolina Pallares-Trujillo V, Moncada-Barrón D, Arroyo-Escalante S, Flores-Nava G, Lavalle-Villalobos A

Language: Spanish
References: 23
Page: 377-383
PDF size: 187.60 Kb.

ABSTRACT

Introduction. Objective: To demonstrate that the detection of 2 positive blood cultures for Klebsiella pneumoniae simultaneously in 2 patients at a neonatal intensive care unit (NICU) may be due to extrinsic contamination.
Methods. Based on an open-labeled, observational, descriptive, crossover study on the outbreak of 2 cases of positive blood culture for K. pneumoniae in NICU, a protocol was designed to take peripheral blood culture and culture samples from endovenous solutions from all patients from January to June 2003. Samples from endovenous solutions were taken (1 mL), twice weekly, at any of the following 3 different time periods: before, during or after instillation. The isolated germs were identified by conventional tests. The variables studied included: gestational age, gender, in-patient days, peripheral or central catheter, diagnosis in patients, primary bacteremia and isolated bacteria. Statistical analysis was performed with mean, mode, median or ratio, range and standard deviation.
Results. One hundred twenty three solutions were included in the same number of patients; 64 (52%) were males and 59 (48%) females. Gestational age was of 33.5 ± 3.6 weeks (median ± standard deviation) (range 27-42 weeks). In-patient days were 13.5 ± 16.4 (range 1-77 days). Forty eight patients (40%) had a central catheter and 75 (60%), a peripheral catheter. Of the endovenous solutions, 59 (48%) were grown before instillation; 64 (52%) during or after the infusion. Positive peripheral blood culture for K. pneumoniae was found in 6 patients (4.8%); after assessing the cultures in their parenteral solutions, a development of the same bacteria was found, leading to the conclusion that the source of contamination comprised the solutions themselves. We proceed to grow the bottle content of the different components for each solution, isolating K. pneumoniae in a 50-mL ampoule containing 20% albumin. Seven patients (5.6%) had positive peripheral blood culture to other microorganisms; Staphylococcus aureus (2), Escherichia coli (1), coagulase-negative Staphylococcus (2), Pseudomonas aeruginosa (1), and Enterococcus faecium (1). In these cases, the parenteral solution culture was negative.
Conclusion. After an exhaustive search, we have demonstrated that the outbreak origin in this case was extrinsic contamination.

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