Outbreak investigation of nosocomial Enterobacter cloacae bacteraemia in a neonatal intensive care unit

W. L. Yu, H. S. Cheng, H. C. Lin, C. T. Peng, C. H. Tsai

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Over a period of 7 months, 23 patients hospitalized in a neonatal intensive care unit (NICU) developed nosocomial Enterobacter cloacae bacteraemia. Contaminated saline for preparing heparin solution was initially identified as the common source of E. cloacae bacteraemia. Although environmental sanitation was enforced, the outbreak continued. E. cloacae has always been isolated from various cultures of the environmental specimens, from the hands of personnel and from the faeces of patients. All of the 23 bacteraemic isolates and 8 stool isolates from infected infants, as well as the 17 isolates from environmental specimens were found to be of the same genotype using the polymerase chain reaction-based DNA fingerprinting method. After various infection control methods were instituted, the outbreak eventually came under control. For epidemiological investigation, 23 neonates without E. cloacae bacteraemia were matched for case-control study. Nineteen (83%) of the case-patients were premature. The significant risk factors leading to E. cloacae bacteraemia in the NICU included small gestation age, low birthweight, exposure to personnel with contaminated hands and the presence of E. cloacae in the stool carriage (p=0.003, 0.007, 0.018 and 0.040, respectively). The gastrointestinal tracts of the patients and environmental surfaces appeared to be the principal sites of bacterial reservoir. In conclusion, the outbreak of E. cloacae bacteraemia was caused by a particular strain and possibly via multiple modes of transmission, including a bottle of contaminated saline as an initial common source, endogenous spread from the gastrointestinal tract and successive cross-infections between patients, hands of personnel and the environment. Effective infection control requires a multidisciplinary approach and reinforcement of infection control procedures, including aseptic technique, hand washing, proper isolation and disinfection of environmental surfaces.

Original languageEnglish
Pages (from-to)293-298
Number of pages6
JournalScandinavian Journal of Infectious Diseases
Volume32
Issue number3
Publication statusPublished - 2000
Externally publishedYes

Fingerprint

Enterobacter cloacae
Neonatal Intensive Care Units
Bacteremia
Disease Outbreaks
Infection Control
Hand
Gastrointestinal Tract
Hand Disinfection
Sanitation
DNA Fingerprinting
Disinfection
Cross Infection
Feces
Heparin
Case-Control Studies
Genotype
Newborn Infant
Pregnancy
Polymerase Chain Reaction

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology

Cite this

Outbreak investigation of nosocomial Enterobacter cloacae bacteraemia in a neonatal intensive care unit. / Yu, W. L.; Cheng, H. S.; Lin, H. C.; Peng, C. T.; Tsai, C. H.

In: Scandinavian Journal of Infectious Diseases, Vol. 32, No. 3, 2000, p. 293-298.

Research output: Contribution to journalArticle

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