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Outbreak of Extended-Spectrum Beta-Lactamase–Producing Klebsiella Pneumoniae in a Neonatal Intensive Care Unit Linked to Artificial Nails

  • Archana Gupta (a1), Phyllis Della-Latta (a2), Betsy Todd (a3), Pablo San Gabriel (a1), Janet Haas (a4), Fann Wu (a2), David Rubenstein (a1) and Lisa Saiman (a1) (a3)...

From April to June 2001, an outbreak of extended-spectrum beta-lactamase (ESBL)–producing Klebsiella pneumoniae infections was investigated in our neonatal intensive care unit.


Cultures of the gastrointestinal tracts of patients, the hands of healthcare workers (HCWs), and the environment were performed to detect potential reservoirs for ESBL-producing K. pneumoniae. Strains of K. pneumoniae were typed by pulsed-field gel electrophoresis using Xbal. A case–control study was performed to determine risk factors for acquisition of the outbreak clone (clone A); cases were infants infected or colonized with clone A and controls (3 per case) were infants with negative surveillance cultures.


During the study period, 19 case-infants, of whom 13 were detected by surveillance cultures, harbored clone A. The overall attack rate for the outbreak strain was 45%; 9 of 19 infants presented with invasive disease (n = 6) or developed invasive disease (n = 3) after colonization was detected. Clone A was found on the hands of 2 HCWs, 1 of whom wore artificial nails, and on the designated stethoscope of a case-infant. Multiple logistic regression analysis revealed that length of stay per day (odds ratio [OR], 1.05; 95% confidence interval [CI95], 1.02 to 1.09) and exposure to the HCW wearing artificial fingernails (OR, 7.87; CI95, 1.75 to 35.36) were associated with infection or colonization with clone A.


Short, well-groomed, natural nails should be mandatory for HCWs with direct patient contact.

Corresponding author
Department of Pediatrics, Columbia University, 622 West 168th Street PH4 West Rm. 470, New York, NY 10032
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Infection Control & Hospital Epidemiology
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