Managing an outbreak of extended spectrum beta-lactamase (ESBL)-producing Klebsiella oxytoca in a Special Care Nursery (SCN)

Debra Vesey1, Paul Chapman1,2, Brian Forde3, Leah Roberts3, Haakon Bergh4, Amy Jennison5, Scott Beatson3, Patrick Harris4,5,6

1Infection Control, Caboolture Hospital, Metro North, QLD, Australia

2QIMR Berghofer, Herston, QLD, Australia

3School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia

4Microbiology Department, Central Laboratory, Pathology Queensland, Royal Brisbane & Women’s Hospital, QLD, Australia

5University of Queensland, UQ Centre for Clinical Research, Royal Brisbane & Women’s Hospital, QLD, Australia

6Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD



An outbreak of an extended spectrum beta-lactamase (ESBL)-producing Klebsiella oxytoca in Special Care Nursery (SCN) was identified during 2017-2018 with a total of ten neonates colonised.

Extensive environmental cleaning and environmental screening during 2017 failed to either identify the source or to eliminate the transmission of Klebsiella oxytoca.


Increased screening of neonates for multi-resistant gram negatives (MRGN) was initiated in December of 2017.

Mothers of the positive neonates were contact traced and admission locations confirmed. Environmental samples from the bedrooms where mothers were admitted as well as communal areas were collected. A baby bath located in a dual-purpose room in the Maternity Unit and a detergent bottle used to clean flower vases, tested positive for Klebsiella oxytoca.


Extensive environmental sampling eventually identified detergent bottles as positive for Klebsiella oxytoca (ESBL producer). Whilst the baby bath and flower basket detergent bottle were positive for Klebsiella oxytoca neither of these sources were attributed to the outbreak in SCN. However, the positive samples assisted in the identification of detergent bottles in SCN that were positive with Klebsiella oxytoca (ESBL producer). Whole Genome Sequencing confirmed detergent bottles as the source of the outbreak with no patient-to-patient transmission.


Outbreak management is resource intensive and requires a team approach to identity and eliminate the source, although identification of the sources is not always possible. Direct observation of practices during an outbreak can assist in identifying work practices which could contribute to transmission.


Debra completed her General Nursing at the RBH in 1987 and worked in a variety of areas before commencing at Caboolture Hospital in 1993. Debra’s initial appointment at Caboolture Hospital was in the Operating Theatres as a Registered Nurse.

In 2000 she commenced as the Clinical Nurse Consultant in Infection Control and completed her Graduate Certificate Infection Control in 2005. Debra is a Credentialed Nurse Immuniser with Metro North Hospital and Health Service.

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