{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:53:52Z","timestamp":1790211232445,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2012,3,24]],"date-time":"2012-03-24T00:00:00Z","timestamp":1332547200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["APMIS"],"published-print":{"date-parts":[[2012,8]]},"abstract":"<jats:p>Neonatal intensive care units (<jats:styled-content style=\"fixed-case\">NICUs<\/jats:styled-content>) are vulnerable to nosocomial outbreaks caused by multiresistant <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>nterobacteriaceae, but no reports of <jats:styled-content style=\"fixed-case\">NICU<\/jats:styled-content> outbreaks of extended\u2010spectrum \u03b2\u2010lactamase (<jats:styled-content style=\"fixed-case\">ESBL<\/jats:styled-content>) producing <jats:italic><jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>lebsiella pneumoniae<\/jats:italic> have previously been published from countries with a low level of antimicrobial resistance such as the <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>candinavian countries. We describe a clonal outbreak of <jats:styled-content style=\"fixed-case\">CTX<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>\u201015 \u2010producing <jats:italic><jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>lebsiella pneumoniae<\/jats:italic> affecting 58 infants in the neonatal intensive care unit at <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>tavanger <jats:styled-content style=\"fixed-case\">U<\/jats:styled-content>niversity <jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>ospital, <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>orway, during a period of 4\u00a0months, 2008\u20132009. The clone spread widely and rapidly in the <jats:styled-content style=\"fixed-case\">NICU<\/jats:styled-content>, and extensive interventions were required to terminate the outbreak. In contrast to previous outbreaks, only one infant acquired a systemic infection caused by the outbreak strain, probably due to a favourable epidemic strain lacking the most common virulence factors. A probable index case was identified, due to multiple positive breast milk samples collected from the infant's mother before and after the infant's transfer from another hospital. Breast milk samples from 3\/18 (17%) mothers of colonized infants were positive for <jats:styled-content style=\"fixed-case\">ESBL<\/jats:styled-content>\u2010producing <jats:italic><jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>. pneumonia<\/jats:italic>e. Vertical transmission of <jats:styled-content style=\"fixed-case\">ESBL<\/jats:styled-content>\u2010producing bacteria has been shown previously,&amp;#146;but the possibility of transmission of <jats:styled-content style=\"fixed-case\">ESBL<\/jats:styled-content>\u2010producing <jats:italic><jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>. pneumoniae<\/jats:italic> through expressed breast milk is reported here for the first time. The increasing occurrence of <jats:styled-content style=\"fixed-case\">ESBL<\/jats:styled-content>\u2010producing&amp;#146;<jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>nterobacteriaceae should therefore encourage changes in diagnostic routines for bacterial screening of breast milk.<\/jats:p>","DOI":"10.1111\/j.1600-0463.2012.02879.x","type":"journal-article","created":{"date-parts":[[2012,3,24]],"date-time":"2012-03-24T14:29:52Z","timestamp":1332599392000},"page":"612-621","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["First outbreak of extended\u2010spectrum \u03b2\u2010lactamase\u2010producing <i><scp>K<\/scp>lebsiella pneumoniae<\/i> in a <scp>N<\/scp>orwegian neonatal intensive care unit; associated with contaminated breast milk and resolved by strict cohorting"],"prefix":"10.1111","volume":"120","author":[{"given":"Siren","family":"Rettedal","sequence":"first","affiliation":[{"name":"Department of Paediatrics Stavanger University Hospital Stavanger Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iren H.","family":"L\u00f6hr","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology Stavanger University Hospital Stavanger Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olav","family":"Nat\u00e5s","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology Stavanger University Hospital Stavanger Norway"},{"name":"Department of Infection Control Stavanger University Hospital Stavanger Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian G.","family":"Giske","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnfinn","family":"Sundsfjord","sequence":"additional","affiliation":[{"name":"Department of Medical Biology Faculty of Health Sciences University of Troms\u00f8 Troms\u00f8 Norway"},{"name":"Department of Microbiology and Infection Control University Hospital of Northern\u2010Norway Troms\u00f8 Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Knut","family":"\u00d8ymar","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Stavanger University Hospital Stavanger Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,3,24]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2008.73"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkl077"},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","DOI":"10.2807\/ese.13.47.19044-en","article-title":"Increasing 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