Harbouring group B streptococci in a neonatal intensive care unit led to an outbreak among preterm infants

We report a nosocomial outbreak with group B streptococci (GBS) in a level two neonatal intensive care unit (NICU) at Sachs’ Children and Youth Hospital, Stockholm, Sweden, in 2014. There were five very preterm infants with severe late‐onset septicaemia, and 10 further infants were colonised. Pulsed‐field gel electrophoresis and multilocus sequence typing genetic characterisation showed that one GBS strain was the cause: serotype Ia, sequence type 23, clonal complex 23. The NICU environment cultures revealed GBS reservoirs on surfaces near sick and colonised patients. We identified workflows and guidelines that could increase the risks of nosocomial infections. Conclusion: This nosocomial GBS outbreak among preterm infants demonstrates that GBS can be harboured in the NICU environment.     

Total parenteral nutrition associated cholestasis: A predisposing factor for sepsis in surgical neonates?

Of 496 neonates and infants less than 1 year of age admitted to the paediatric surgical intensive care unit (PSICU) over a 5 year period (1983–1987), 94 required total parenteral nutrition (TPN) for more than 14 consecutive days, generally due to congenital anomalies of the digestive tract. Cholestasis occurred in 15 of them and 12 of these patients developed sepsis. In contrast, of the 79 patients on TPN that remained free from cholestasis, only 23 developed sepsis. The mortality rate for the TPNAC-group was substantially higher than for the group without TPNAC. It is suggested that development of TPNAC might lead to impairment of non-specific cellular immunity in neonates.     

Septikämien bei Leukämien und malignen Lymphomen

Summary Septicemia ocurred in 81 (=23.9%) of 339 patients with leukemias an malignant lymphomas during 1979–1984/VI. In leukemias the acute forms and in malignant lymphomas the high malignant forms were mostly affected. The frequency of gramnegative bacterias (46=56.8%) was higher than that of gram-positive bacterias (32=39.5%) and of fungus (3=3.7%). The frequency of septicemia in leukemias (alone) between 1966–1977 was 13.9%, between 1979–1984/VI 30%. In this comparison septicemias caused by gram-negative bacterias and fungus decreased, whereas gram-positive septicemias increased. The focus of septicemia remained unknown in 30 cases, Pneumonias and the urinary tract were the most common source, followed by the skin. All patients were under cytostatics and therefore leukopenic, most of them received corticosteroids simultaneously and were thus immunsuppressed. A combination of granulocytopenia <1,000 mm³ with hypogammaglobulinemia <10 rel.% were mostly found in acute leukemias and in chronic lymphatic leukemia. 41.5% of febrile episodes from all groupes of these diseases were of non-microbic origin (local or septic) an thus possibly symptom of activity of the underlying disease.

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Abkürzungen AL akute Leukämie - CLL chronisch lymphatische Leukämie - CML chronisch myeloische Leukämie - NHL Non-Hodgkin-Lymphome     

Platelet-activating factor concentrations in healthy and septic neonates

Platelet-activating factor levels were measured in nine preterm infants with Klebsiella pneumonia septicaemia, eight healthy preterm infants of similar gestational age and ten healthy full-term infants of the same postnatal age at sampling. The platelet-activating factor levels of the healthy preterm and term groups did not differ significantly, but were elevated compared to the other two groups in the septic preterm infants (P < 0.01). Conclusion Platelet-activating factor levels increase upon stimulation by Gram negative bacteraemia and are a important mediator of neonatal sepsis. Received: 11 March 1998 / Accepted in revised form: 8 February 1999     

An outbreak of Serratia marcescens septicaemia in neonatal intensive care unit in Gaza City, Palestine

We performed a case-control study of Serratia marcescens incidence in the neonatal intensive care unit of a governmental Gaza Strip hospital from January to December 2005. S. marcescens was detected in the blood of 159 confirmed nosocomial cases of septicaemia, 70 (44%) neonates died due to S. marcescens infection and 89 recovered. The main clinical symptoms were hypothermia 38%; jaundice 42%; Apgar score 4 at 1min in 29% of neonates; and Apgar score 5 at 5min in 5%. Risk factors significantly associated with S. marcescens infection were birthweight <1500g (OR: 1.7; P=0.026); <37 weeks gestational age (OR: 2.0; P=0.002); and use of mechanical ventilation (OR: 2.3; P=0.001). Agar diffusion susceptibility testing indicated that S. marcescens was generally susceptible to imipenem, followed by ciprofloxacin and ofloxacin. We identified potential risk factors associated with development of neonatal sepsis and highlight the importance of appropriate infection control measures to prevent serious infection.     

Staphylococcus aureus bacteraemia in children and neonates: a 10 year retrospective review

Rates of Staphylococcus aureus bacteraemia (SAB) are published performance indicators for hospital-acquired infection. In adults SAB is often associated with central venous catheters (CVC), mortality is high and up to 40% are MRSA. However, there is little data on SAB in neonates and children in the UK.

Aim

To describe the presentation, management and outcome of SAB on a neonatal and paediatric unit in a District General Hospital (DGH) over a 10 year period.

Method

Case notes of children < 16 years with SAB between May 1993 and April 2003 were studied. SAB which developed >48 h after admission was defined as hospital-acquired. Contamination was probable if the clinical picture was unsupportive of infection, or if repeat culture was negative and no treatment was given.

Results

Neonatal unit: Thirty-three of 40 episodes were reviewed (median gestation 32 weeks, median age 21 days). Three of 33 (9%) were contaminants. All SAB were hospital acquired. Twenty-six of 30 (87%) had non-specific presentation, but 15 developed a focus of infection (skin 12, chest 3). Seventeen (57%) infants had CVCs. Eight (27%) infants had MRSA bacteraemia, seven with CVCs. Three (10%) infants died.Paediatric unit: Sixty-four of 70 episodes were reviewed (median age 2 years). Thirteen of 64 (20%) were contaminants. Ten of 51 (20%) were hospital acquired. Presentations were with skin infection 18, bone/joint infection 13, non-specific 13, respiratory 8. Only two had MRSA, one with CVC. One (2%) child died, from an unrelated cause.

Conclusion

SAB on a paediatric unit shows a very different pattern compared to SAB in adults. The pattern on a neonatal unit is more similar to that in adults. Both children and neonates have a lower mortality and a lower incidence of MRSA, whilst paediatric SAB has a weaker association with CVC. The proportion of SAB which is hospital acquired is low on a paediatric unit, making SAB an unreliable performance indicator. Most SA in blood cultures are not due to contamination. Prospective studies are needed to determine appropriate investigation and treatment.     

Diphtheritic septicaemia and probable endocarditis: A case report and review of the literature

Corynebacterium diphtheriae usually produces an infection limited to the respiratory tract and the organisms rarely invade the blood stream. We report the case of a 6-year-old girl who, 2 months after an unsuccessful repair of a ventricular septal defect, developed septicaemia with nontoxigenic C. diphtheriae. The organism appeared resistant to penicillin in vitro and failed to respond to a course of trimethoprim-sulfamethoxazole to which it was susceptible in the laboratory. A cure was finally achieved using cephalothin and gentamicin, followed by an additional course of ampicillin and amoxicillin. Twelve previously recorded cases of diphtheritic sepsis and endocarditis are reviewed.Abbreviations VSD ventricular-septal defect - TMS trimethoprim-sulfamethoxazole