AN OUTBREAK OF ANTIBIOTIC MULTIRESISTANT KLEBSIELLA AT THE NEONATAL INTENSIVE-CARE UNIT, KAPLAN-HOSPITAL, REHOVOT, ISRAEL, NOVEMBER 1991 TOAPRIL 1992

From November 1991 through April 1992, 8 infants developed systemic in fections due to antibiotic multiple resistant Klebsiella (MRK). All we re premature and 6 of the 8 weighed less than 1100 g; 7 of the 8 had r eceived previous antibiotic therapy. Five infections occurred during t he first week of life. MRK were isolated from blood (8 cases), trachea l secretions (TS-6), stool (3), anti CSF (1). All Klebsiella blood iso lates were resistant to ampicillin, mezlocillin, and cefotaxime, 7 of 8 to ceftazidime and amikacin, and 4 of 7 to aztreonam; all isolates w ere 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 inappro priate. The outbreak was terminated by temporary closure of NICU in Ma y 1992. Strict hand washing practices were reemphasized, and the previ ous empiric antibiotic protocol used for suspected sepsis (mezlocillin plus amikacin, and lately ceftazidime plus amikacin) was changed to i mipenem and amikacin in the risk population. At closure, 5 additional infants had MRK in stools and/or tracheal suction specimens. Developme nt of MRK organisms should dictate a rational use of empiric antibioti cs for neonatal infections in NICU.