Nosocomial colonization of premature babies with Klebsiella oxytoca: Probable role of enteral feeding procedure in transmission and control of the outbreak with the use of gloves

OBJECTIVE: To investigate the persistence of colonization of premature babi es by Klebsiella oxytoca, with special emphasis on the mode of transmission of the bacterium and evaluation of Standard Precautions to stop the epidem ic. DESIGN: Retrospective analysis of cases and prospective study of systematic bacteriological samples (stools and throat) from babies, healthcare worker s (HCWs), and environment, with genotyping of strains by arbitrarily primed polymerase chain reaction. S ETTING: A premature baby unit (PBU) and a neonatal intensive care unit in t he university hospital of Saint-Etienne, France. RESULTS: An outbreak of K oxytoca was suspected in two pediatric wards afte r the occurrence of a fatal bacteremia in a newborn hospitalized in the PBU and the colonization of other babies 2 months later. Retrospective analysi s showed that 24 babies' digestive tract had been colonized. No environment al reservoir was recovered in the units nor in enteral feeding. No K oxytoc a was isolated from HCW samples. Genotyping confirmed the presence of epide mic strains, although independent clones were responsible for infections or colonizations in each of the two units. The chronology and the site of bab ies' colonization (isolation of K oxytoca in stools before throat) were det ermined during a prospective study and suggested that enteral feeding proce dures could be the source of contamination. Therefore, use of gloves during this practice by HCWs was recommended and, after readjustment of Standard Precautions, stopped the outbreak. CONCLUSION: To prevent cross-contamination among high-risk babies, careful attention must be paid to Standard Precautions. Bacteriological surveillanc e of the digestive tract of neonates could help to check compliance with th ese guidelines.