Klebsiella: Harmless to Problematic

BACKGROUND: Klebsiella pneumoniae (KPNE), previously an innocuous bug in our pediatric burn unit, changed its characteristics recently. A 13-year-old male was admitted from Mexico with a third-degree 60% TBSA flame burn. We isolated from his burn wound tracheal aspirate, banked autograft skin, and grew a KPNE sensitive only to Amikacin and Gentamycin. Over the next 3 months, this organism was isolated from 13 additional burn patients. METHODS: A search for a reservoir included water samples from OR and tub room hoses, various equipment cultures from both areas, and the burn unit. Peri-rectal swabs and tube feed stocks were monitored weekly. RESULTS: KPNE was recovered from two pieces of equipment in one of the ORs, a patient room (post discharge and cleaned), and one container of tube feed stock. The OR and patient room were temporarily closed for aggressive cleaning. Procedural changes were made for mixing and hang time of tube feedings. CONCLUSION: Ten of fourteen patients utilized the operating room where the KPNE was found, which implicated the OR suite as the potential source of transmission. The peri-rectal swabs showed no sign of the organism. Cleaning procedures have been reviewed, and cleaning rooms between cases is a joint effort of OR staff and Environmental Services with close attention to detail. Follow-up random cultures of clean ORs have not recovered the organism