Septicemia due to multiresistant Klebsiella pneumoniae in a neonatal unit:A case-control study

An unusually high incidence of septicemia due to multiresistant Klebsiella pneumoniae occurred in the Aristotle University Neonatology Department. For ty neonates suffered from 42 episodes of septicemia. Mortality was 43% rang ing from 32% in neonates with birth weight (BW) greater than or equal to 15 00 g to 55% with < 1500 g. No differences were found between 17 neonates wh o died and 23 survivors. All isolates were resistant to aminoglycosides, th ird-generation cephalosporins, and aztreonam, but susceptible to imipenem a nd ciprofloxacin. The neonates with septicemia due to K. pneumoniae were ma tched 1:1 with neonates without septicemia (31 pairs) or with neonates with septicemia due to other organisms (8 pairs) according to BW and time of ad mission. Factors associated with septicemia were mechanical ventilation (p = 0.004) and ongoing parenteral nutrition (p = 0.027). In a multivariate mo del, nutrition exhibited no independent association after adjusting for ven tilation. No differences were detected between the patients with Klebsiella septicemia and those with septicemia due to other organisms. Enhanced Infe ction Control measures and a temporary change of antibiotic policy reduced this serious complication. Three small outbreaks of multiresistant K. pneum oniae previously reported in neonates are reviewed.