Evaluation of Klebsiella infections in the tertiary neonatal intensive care unit

Aim: In this study, we aimed to determine the frequency, demographic characteristics, associated risk factors, resistance patterns and factors affecting mortality and morbidity of Klebsiella infections in hospitalized neonatal patients. Material and Methods: Neonates who were identified with culture-proven Klebsiella infection in NICU were included in the patient group, and those who were admitted to the same unit on the same day and did not suffer from Klebsiella infection were selected as a control group. Results: One hundred nine patients and 417 patients were included in the study as patient group, and control group, respectively. Extended-spectrum & beta;-lactamase (ESBL) producing K. pneumoniae was detected in 79% of the patients while CRKP infection was detected in 26%. Fetal distress exposure (p=0.032), prematurity (p=0.004), prior hospitalization (p=0.024), peripherally inserted central venous catheterization (p=0.018), urinary (p=0.003) and nasogastric catheterization (p=0.003), total parenteral nutrition (TPN) use (p=0.008), and long-term hospitalization (p<0.001) were found to be risk factors for Klebsiella infection. The sensitivity of colistin and meropenem were 100% and 87.9% in antibiograms. Previous antibiotic use (p=0.002) and mortality (p=0.033) were higher in patients with CRKP infection compared to the carbapenem sensitive patient group. CRKP infection developed in 21% of patients with CRKP colonization. Discussion: Prior hospitalization, prematurity, and invasive procedures are important risk factors for Klebsiella infections in neonates. Mortality and previous antibiotic use are much higher in patients with CRKP infection than in the carbapenem sensitive group. To prevent and control Klebsiella infections, minimally invasive procedures, strict infection control protocols, and rational use of antibiotics are required. Overuse of colistin should be limited to prevent colistin-resistant Klebsiella outbreaks in NICUS in the near future.