During 1991, Klebsiella sp. was the most common organism isolated from blood of nursery patients of one hospital in Saudi Arabia. We began an investigation to identify risk factors and make recommendations for control.
Methodology
We defined a case of Klebsiella septicemia as any nursery patient with Klebsiella found on blood culture. For each case we selected one control infant with the same room and physiological severity of illness. We compared cases and controls for gestational age, admission diagnosis, place and type of delivery. We compared them for exposure to ventilator and nasogastric tube within seven days prior to onset, and intravenous (IV) fluids, medications, blood products, peripheral IV lines and umbilical catheters within 3 days before onset.
Results
From February 15 to May 14, 1991, we identified 20 cases of primary Klebsiella bacteremia (4 per 100 discharges). Sixty percent died representing 17% of all nursery deaths. Case infants did not differ from controls with regard to any exposure in the nursery or preexisting condition except one. They were more likely to have received 10% dextrose in 0.2 normal saline prior to the Klebsiella positive blood culture (OR=14, p=0.002 Fisher exact test). This was the most commonly used intravenous fluid. Colonization rates with Klebsiella were 35% for both cases and controls. Lacking certain IV equipment, nurses perforce disconnected the umbilical catheter from the intravenous line to sample blood or inject medication. After providing three way stopcocks and injection ports and prohibiting the opening of IV lines for sampling or injection, the incidence rate fell to 1% in the next month.
Conclusion
We believe that the frequent opening of the IV line allowed contamination of IV fluids with Klebsiella. The 35% colonization rate in the nursery probably contributed.