Nosocomial outbreak of extended-spectrum beta-lactamase-producing Salmonella isangi in pediatric wards

Since May 2000, extended-spectrum beta-lactamase-producing (ESBL) Salmonella Isangi were isolated from pediatric patients at a tertiary hospital. A total of 41 patients with positive cultures were reviewed, and the majority presented with gastroenteritis, fever, or both. One ESBL phenotype was noted in all isolates, and clonality was confirmed by pulsed-field gel electrophoresis. This is the first report of Salmonella sp. ESBL resistance in our hospital.     

The evaluation of clusters of hospital infections due to multidrug-resistant Salmonella enterica serovar typhimurium in the neonatal unit: a two-year experience

Seven clusters of hospital infection due to Salmonella enterica serovar typhimurium were documented in the neonatology clinic of a children's hospital between April 2002 and March 2004. Eighty-one neonates were infected. Three cases were asymptomatic, 73 cases had gastroenteritis as the only clinical condition, and 5 cases had bacteremia associated with gastroenteritis. All isolates from stool and blood samples (n=86) were identified as Salmonella enterica serovar typhimurium. Extended-spectrum beta-lactamase (ESBL) production was determined by clavulanate disk potentiation assay in all isolates. Enterobacterial Repetitive Intergenic Consensus polymerase chain reaction (ERIC-PCR) was performed in 26 selected isolates, which were chosen as being representative of different clusters, to determine the clonal relationship. PCR, isoelectric focusing and sequence analysis revealed the production of CTX-M-3, TEM-1 and SHV-12 by these isolates in 23%, 76.9% and 100%, respectively. None of the isolates had PER beta-lactamase production. Standard infection control measures such as handwashing and disinfection procedures were implemented in initial clusters. During the two-year period, the infection control policy of the hospital was improved with appropriate actions such as assignment of an infection control nurse and increasing the number of staff of the clinic, and finally, with the establishment of an active surveillance program, the clusters were stopped.     

Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infection in a neonatal intensive care unit

Background

A molecular epidemiological survey was conducted on an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBLKp) infection in our neonatal intensive care unit (NICU) from February to June 2008.

Methods

Cultures of clinical samples from neonates in the NICU, the hands of healthcare workers and the environment of the NICU were subjected to ESBLKp isolation. Pulsed-field gel electrophoresis was performed to determine Klebsiella pneumoniae strains (type A-D).

Results

In 1439 neonates, 38 (2.6%) had infections and 65 (4.5%) had colonizations with ESBLKp. Microbiological sampling of the NICU environment yielded 33 (14.9%) ESBLKp isolates from 222 samples. Clone A was found in 88.2% of the infected neonates, 66.7% of the colonized neonates, 69.7% of the environmental samples, and the hands of a healthcare worker.

Conclusions

The detection rate of ESBLKp is high in environmental samples, especially those from frequently touched surfaces. Since ESBLKp was identified on the hands of a healthcare worker in the present study, hand and environmental hygiene is mandatory for infection control in neonatal intensive care units.     

Salmonella senftenberg outbreak in a neonatal unit

Salmonella senftenberg was isolated from the stools of 35 newborns between June, 1987 and September, 1988. Twenty nine (82.8%) babies were preterms and twenty six (74%) babies were less than 2,000 grams in weight. All of them were symptomatic within 6 days of life, 74.3% (26) within 4 days. All of them had loose stools and weight loss. Other features were sclerema, jaundice and paralytic ileus. The organism was sensitive to nalidixic acid (100%), amikacin (94.6%), gentamicin (72.9%), cephaloridine (56.7%), and chloramphenicol (29.8%) and resistant to benzyl penicillin and ampicillin. Babies showed good response to a combination of cephaloridine and amikacin along with supportive care. Five babies died, 4 of septicemic shock and one of pulmonary hemorrhage.     

Clinical features of nosocomial infections by extended-spectrum beta-lactamase-producing Enterobacteriaceae in neonatal intensive care units

AIM: To determine the risk factors for the acquisition of nosocomial extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae infection in infants hospitalized in neonatal intensive care units (NICUs) and to evaluate the therapeutic outcome of these infants. METHODS: We retrospectively reviewed the medical records of infants with nosocomial ESBL-producing Enterobacteriaceae infection hospitalized in NICUs at Chang Gung Children's Hospital in 2001. The clinical features of these infants were compared with a cohort of non-ESBL-producing Enterobacteriaceae-infected infants during the same period. The therapeutic outcome of the infants in the ESBL group was analysed. RESULTS: Seventy infants were included in this study. Thirty-one infants with 34 isolates were identified in the ESBL group and 39 infants with 42 isolates in the non-ESBL group. Of the parameters analysed, including gestational age, birthweight, length of hospital stay before onset, the number of antibiotics used, the duration of third-generation cephalosporin usage and the number of patients receiving a third-generation cephalosporin prior to the onset of infection, no significant difference was found between the two groups. The infection-contributed case fatality rate was 3.0% (1 of 33) in the ESBL group, not significantly different from that in the non-ESBL group (1 of 41, 2.4%). Of the 31 patients in the ESBL group, 18 were treated with a carbapenem as definitive therapy while 13 were treated with a non-carbapenem antibiotic regimen. No significant difference was noted in terms of mortality rate between the two subgroups.CONCLUSION: The outcome of the infants hospitalized in the NICU with ESBL-producing enterobacterial infections was not indispensably grave, even when treated with a non-carbapenem antibiotic regimen. The risk factors for the acquisition of ESBL-producing enterobacterial infections in these infants were not identified in this series.     

Pseudomonas aeruginosa infections due to electronic faucets in a neonatal intensive care unit

Aim: To evaluate the role of electronic faucets in a newborn intensive care unit during a Pseudomonas aeruginosa outbreak. Methods: After three patients had P. aeruginosa bacteremia, environmental cultures including those from patient rooms, incubator, ventilators, total parenteral nutrition solutions, disinfection solutions, electronic and hand‐operated faucet filters/water samples after removing filters and staff hands were taken. Results: Only filters of electronic faucets and water samples after removing filters and one liquid hand soap showed P. aeruginosa (3–7 × 106 cfu/mL). We have removed the electronic faucets and new elbow‐operated faucets were installed. Pulsed‐field gel electrophoresis analysis of outbreak‐blood culture isolates from two patients and isolates from electronic water faucets/one liquid hand soap indicated the presence of 90.7% genetically related subtype, probably from the same clone. Water cultures from new faucets were all clean after installation and after 7 months. Conclusion: We suggest that electronic faucets may be considered a potential risk for P. aeruginosa in hospitals, especially in high‐risk units.     

Outbreak of extended spectrum beta-lactamase-producing Klebsiella pneumoniae infection in a neonatal intensive care unit related to onychomycosis in a health care worker

Four cases of infection by extended spectrum beta-lactamase-producing Klebsiella pneumoniae occurred in the neonatal intensive care unit. Isolation, empiric therapy change and education produced no effect. Newborn weekly colonization rates were 0-18.7%. One health care worker with onychomycosis was positive for extended spectrum beta-lactamase-producing K. pneumoniae. Isolates were identical by molecular typing. Outbreak was controlled when the health care worker was excluded from the neonatal intensive care unit.     

Nosocomial meningitis due to Campylobacter fetus subspecies fetus in a neonatal intensive care unit

We experienced a nosocomial outbreak of Campylobacter fetus subspecies fetus ( C. fetus ) meningitis in a neonatal intensive care unit. A cluster of three infants developed meningitis approximately 1–1.5 months after the index patient was admitted. Two asymptomatic intestinal carriers of C. fetus were detected during the outbreak. Our experience indicates that C. fetus can cause nosocomial meningitis in neonates, and asymptomatic carriers may play a role in the transmission of the organism.     

Late-onset sepsis due to Salmonella Typhi in a preterm infant in a French neonatal unit

We report a case of late-onset sepsis caused by Salmonella Typhi in a one-month old preterm infant hospitalised in our neonatal unit. An investigation of the index case was undertaken to identify the source of contamination. The patient made a complete recovery.     

Referrals to a regional neonatal intensive care unit.

Over a three year period 444 requests for the neonatal transfer of babies with acute medical problems were received at this regional neonatal medical unit. Despite an increase in available resources in the North Western Health Region the provision of intensive care remained inadequate with 38% of requests declined, and babies had to be referred elsewhere including to neighbouring health regions. The survival of those babies who had to remain at the hospital of birth (49%) was significantly lower than for those transferred to the regional centre (71%). Those babies declined admission had significantly lower gestational ages and birth weights than those accepted. For those babies with respiratory failure and birth weights of less than 1500 g within these two groups, however, there were no significant differences in birth weight, gestational age, or gender yet survival was significantly better for those transferred. Babies from multiple pregnancies caused particular problems if neonatal transfer was required.     

Insulin infusions in the neonatal unit: delivery variation due to adsorption

OBJECTIVE: To assess the extent of the variability in insulin delivery over time, under conditions used in Australian neonatal units, studying the following variables: diluent, preconditioning, flushing, sequential preconditioning and flushing, insulin concentration, flow rate, catheter type, and addition of albumin. METHODOLOGY: A range of simulated insulin infusions was studied. Infusions were run over 22 h, with aliquots of infusate collected at baseline and after 15 min, 30 min, 1 h, 2 h, 6 h and 22 h. Insulin concentration was assayed using a radioimmunoassay. RESULTS: An infusion of 50 mU insulin/mL at 1 mL/h gave negligible insulin delivery until 22 h. However, after preconditioning and flushing the tubing, consistent insulin delivery was attained by 6 h. An infusion of 200 mU insulin/mL at 1 mL/h did not provide consistent delivery until 6 h. At this concentration and rate, consistent insulin delivery was attained within 30 min of the start of the infusion either by preconditioning and flushing the tubing, or by addition of albumin to the infusate. CONCLUSION: Clinically significant variation in intravenous insulin delivery will occur in the neonatal setting unless counter-measures are taken, such as sequential preconditioning and flushing of the delivery system or the addition of albumin to the infusate.