KLEBSIELLA-PNEUMONIAE BLOOD-STREAM INFECTIONS IN NEONATES IN A HOSPITAL IN THE KINGDOM OF SAUDI-ARABIA

OBJECTIVE: To identify risk factors for Klebsiella pneumoniae bloodstr eam infections (BSI) in neonates in a hospital in the Kingdom of Saudi Arabia (KSA). DESIGN: Two case-control studies among hospitalized neo nates during February 15-May 14, 1991, and a procedural and microbiolo gical investigation. SETTING: Hospital A, a maternity and children's h ospital in KSA. PATIENTS: Case patients had a blood culture positive f or K pneumoniae after >2 days of hospitalization and had no evidence o f a nonblood primary site of infection. RESULTS: When the 20 case pati ents were compared with controls, hospitalization in a critical-care u nit (odds ratio [OR], 5.5; 95% confidence interval [CI95], 1.20-51.1; P=.03) was identified as a risk factor. When the case patients were co mpared with a second set of controls matched by critical-care status, receipt of a particular intravenous fluid (D10%/0.2NS; OR, 11.0; CI95, 1.42-85.2; P=.009) or a blood product (OR undefined; P=.04) were iden tified as risk factors. Infusates were administered via umbilical cath eters for most case and control patients (19/20 vs 15/20, P>.05); cath eters were manipulated more frequently in patients in critical-care un its. Umbilical catheter tip, skin, or mucus membrane K pneumoniae colo nization occurred in 47% and 53% of evaluated case and control patient s, respectively. Available K pneumoniae isolates from blood cultures a nd colonization sites had identical antimicrobial susceptibility patte rns. Emphasis on handwashing, careful preparation and administration o f infusates, and aseptic technique for catheter insertion, maintenance , and manipulation was temporally associated with resolution of the ep idemic. CONCLUSIONS: This outbreak was probably due to infusion therap y practices that led to BSI in nursery patients colonized with K pneum oniae. Both catheter-related infections and extrinsic contamination of infusates may have occurred. Hospital personnel should be aware of th eir potential to spread nosocomial pathogens from person to person and should implement Centers for Disease Control and Prevention recommend ations to decrease nosocomial BSIs (Infect Control Hosp Epidemiol 1998 ;19:674-679).