Characterization of an outbreak due to extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a pediatric intensive care unit transplantpopulation

Limited information exists regarding Klebsiella pneumoniae's production of an extended-spectrum beta -lactamase (KP-ESBL) in pediatric patients, parti cularly solid-organ transplant recipients. This study characterized the mic robiological, 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 duri ng a 21-month period were reviewed. ESBL production was defined by double-d isk diffusion, and 6 distinct pulsed-field gel electrophoresis patterns wer e identified. Fifty-six percent of the transplant patients we studied devel oped KP-ESBL, representing 87% of all microbiologically confirmed cases at our institution. As compared with 16 control transplant patients who were n egative for KP-ESBL, the 20 transplant patients who acquired KP-ESBL were y ounger (aged less than or equal to5 years; 80.0% vs. 43.8%,) and experience d placement of greater than or equal to3 central venous catheters P =. 038 before recovery of the first K. pneumoniae isolate (73.7% vs. 18.8%,). This study P =. 002 suggests that children who receive liver or intestinal tran splants are at high risk for KP-ESBL acquisition.