Klebsiella Infection in an European Surveillance Neonatal Network
C. Kortsalioudaki, A. Kent, J. Kopsidas, T. Watts, T. Scorrer, I. Lutsar, M. Turner, P. Clarke, K. Karachristou, A. Collinson, J. Chang, G. Dimitriou, N. Spyridis, T. Zaoutis, PT. Heath; on behalf of the Neonatal Infection Surveillance Network (neonIN); London, Portsmouth, Liverpool, Norwich and Truro (UK), Athens (Greece) and Tartu (Estonia)
4th International Congress of Union of European Neonatal and Perinatal Societies (UENPS)
December 11th-14th, 2014, Athens, Greece
BACKGROUND AND AIMS: Klebsiella spp. are a common cause of hospital-acquired, Gram-negative infections within neonatal units (NNUs) and responsible for outbreaks. This study describes characteristics of invasive Klebsiella spp. infections across European countries participating in a neonatal infection network.
METHODS: NeonIN is a web-based surveillance database for culture proven neonatal infections. Klebsiella spp. cases from 2004-2014 were extracted. Early-onset sepsis (EOS) was defined as occurring within 48 hours of birth.
RESULTS: 158 episodes from 33 NNUs (involving 149 neonates) were reported. The incidence and prevalence by country is shown in Tab. 1, while details of the pathogens and the demographics are in Tab. 2. Overall, K. pneumoniae was the commonest subspecies (59, 37.3%) followed by K. oxytoca (55, 34.8%) and K. aerogenes (22, 14.0%). There were 22 reports of non-speciated Klebsiella. EOS was rare (3 episodes, all K. pneumoniae). Klebsiella spp. were predominantly isolated from blood (136, 86.1%) and were isolated together with other pathogens in 15% (24) of cultures. Median CRP was 102 mg/dl (IQR 30-145). Amongst the subspecies K. aerogenes infection occurred in more premature neonates (median 25 vs 28 weeks gestation-age, p = 0.05). Resistance to aminoglycosides (21/126, 16.7%) and 3rd generation cephalosporins (11/88, 12.5%) was detected while all tested isolates appeared susceptible to quinolones (62/62, 100%) and carbapenems (67/67, 100%).
CONCLUSIONS: Klebsiella spp. infections are an important cause of LOS in mainly very preterm infants. The epidemiology varies by country; knowledge of local antibiotic susceptibility is therefore required to guide empiric LOS therapy and to direct effective infection-control measures.
Table 1. Incidence and prevalence of Klebsiella spp. infections by country.
| UK | Greece | Estonia | p-value | ||||
| Number of Neonatal Units | 20 | 7 | 5 | - | |||
| Total number of infection episodes (IE) | 3,050 | 136 | 163 | - | |||
| Incidence of IE (NNU admissions) | 39.2/1,000 | 63/1,000 | 50.3/1,000 | < 0.001 | |||
| Overall % of GNS (of all IE) | 18.7 | 41.2 | 26.4 | < 0.001 | |||
| Incidence of GNS (NNU admissions) | 7.3/1,000 | 26.0/1,000 | 13.3/1,000 | < 0.001 | |||
| % of Klebsiella spp. infection (of all GNS) | 22.0 | 35.7 | 30.2 | 0.02 | |||
| Incidence of Klebsiella spp. (NNU admissions) | 1.6/1,000 | 9.3/1,000 | 4.0/1,000 | < 0.001 | |||
GNS: Gram-negative sepsis.
Table 2. Details of isolated pathogens and demographics.
| UK(n=125) | Greece(n=20) | Estonia (n=13) | p-value | ||||
| Predominant Klebsiella spp.(n[%]) | K. oxytoca: 40 (32.0%) | K. pneumoniae: 12 (60.0%) |
K. oxytoca: 9 (69.2%) |
- | |||
| Sex (male) | 65 (53%) | 14 (70%) | 5 (38.5%) | 0.173 | |||
| Gestational age at birth (weeks) | 26 (25-30) | 33.5 (28-36.5) | 29 (24-35) | < 0.001 | |||
| Birth weight (g) | 821 (666-1,140) | 1,730 (1,000-2,230) | 1,480 (846-2,740) | < 0.001 | |||
| PNA (days) | 34 (16-69) | 23.5 (9.5-70.5) | 15 (10-50) | 0.257 | |||
| cGA (weeks) | 32.7 (26.7-39) | 37.4 (34.9-44) | 36.7 (31-38.1) | 0.011 | |||
| Treated for meningitis (n [%]) | 13 (10.4%) | 1 (5%) | 1 (7.5%) | 0.920 | |||
Median (IQR).
PNA: post-natal age at the time of infection, cGA: corrected gestational age at the time of infection.