Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-28T00:36:07.020Z Has data issue: false hasContentIssue false
  • English
  • Français

Molecular Epidemiology of Systemic Infection Caused by Enterobacter cloacae in a High-Risk Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Rogerio Hakio Kuboyama ,
Helenice Bosco de Oliveira  and
Maria Luiza Moretti-Branchini
Rogerio Hakio Kuboyama
Affiliation:
Infectious Diseases Division and Epidemiology Division, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
Helenice Bosco de Oliveira
Affiliation:
Infectious Diseases Division and Epidemiology Division, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
Maria Luiza Moretti-Branchini*
Affiliation:
Infectious Diseases Division and Epidemiology Division, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
*
Infectious Diseases Division, Faculty of Medical Sciences, UNICAMP, Rua Alexandre Fleming, 40, Cidade Universitária Zeferino Vaz, 13081-970, Campinas, São Paulo, Brazil
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate the molecular epidemiology of systemic nosocomial infections caused by Enterobacter cloacae.

Setting:

Neonatal intensive care unit (NICU) of a tertiary-care university hospital.

Patients:

Forty-two high-risk neonates with systemic infections caused by E. cloacae.

Methods:

From 1995 to 1997, the variables associated with death in these patients were evaluated. The molecular epidemiology of the strains responsible for the systemic infections, and 14 unrelated strains, was studied using plasmid analysis and pulsed-field gel electrophoresis (PFGE).

Results:

The overall mortality rate for infection caused by E. cloacae was 34%, whereas the crude mortality rate during the study period was 8.12% (P < .001). Gestational age (preterm neonates) and birth weight (small for gestational age) were not associated with a higher risk of death. Insertion of a venous catheter by dissection of a peripheral vein was the only invasive procedure related to death (P = .016) in this study. A molecular analysis showed that three outbreaks, each occurring in a different year, were caused by strains with distinctive DNA profiles. Only one outbreak was identified by the infection control service, in the NICU. Plasmid analysis and PFGE showed similar ability to discriminate control strains from the E. cloacae strains isolated from the neonates.

Conclusions:

Systemic infections caused by E. cloacae in our NICU were associated with a high mortality rate and occurred as small, unrecognized outbreaks. These results may not be generalizable because the data were from a single center (Infect Control Hosp Epidemiol 2003;24:490-494).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 7 , July 2003 , pp. 490 - 494
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Fok, TF, Lee, CH, Wong, EMC, et al. Risk factors for Enterobacter septicemia in a neonatal unit: case-control study. Clin Infect Dis 1998;27:1204–1209.Google Scholar
2.Haertl, R, Bandlow, G. Epidemiological fingerprinting of Enterobacter cloacae by small-fragment restriction endonuclease analysis of genomic restriction fragments. J Clin Microbiol 1993;1:128–133.Google Scholar
3.Fernandez-Bacca, V, Ballesteros, F, Hervas, JA, et al. Molecular epidemiological typing of Enterobacter cloacae isolates from a neonatal intensive care unit: three-year prospective study. J Hosp Infect 2001;49:173–182.CrossRefGoogle Scholar
4.Calil, R, Marba, STM, Nowakonski, AV, Tresoldi, AT. Reduction in colonization and nosocomial infection by multiresistant bacteria in a neonatal unit after institution of educational measures and restriction in the use of cephalosporins. Am J Infect Control 2001;29:133–138.Google Scholar
5.Tresoldi, AT, Padoveze, MC, Trabasso, P, et al. Enterobacter cloacae sepsis outbreak in a newborn unit caused by contaminated total parenteral nutrition solution. Am J Infect Control 2000;28:258–261.CrossRefGoogle Scholar
6.Van Nierop, WH, Duse, AG, Stewart, RG, Bilgeri, YR, Koornhof, HJ. Molecular epidemiology of an outbreak of Enterobacter cloacae in the neonatal intensive care unit of a provincial hospital in Gauteng, South Africa. J Clin Microbiol 1998;36:3085–3087.CrossRefGoogle ScholarPubMed
7.Centers for Disease Control and Prevention. Nosocomial infection rates for interhospital comparison: limitations and possible solutions. Infect Control Hosp Epidemiol 1991;12:609–621.CrossRefGoogle Scholar
8.Townsend, DE, Ashdown, N, Bolton, S, Grubb, WB. The use of cetyltrimethylammonium bromide for the rapid isolation from Staphylococcus aureus of relaxable plasmid DNA suitable for in vitro manipulation. Lett Appl Microbiol 1985;1:87–94.CrossRefGoogle Scholar
9.Seifert, H, Schulze, A, Baginski, R, Pulverer, R. Comparison of four different methods for epidemiologic typing of Acinetobacter baumannii. J Clin Microbiol 1994;32:1816–1819.Google Scholar
10.Goering, RV, Duesing, TD. Rapid field inversion gel electrophoresis in combination with an rRNA gene probe in the epidemiological evaluation of staphylococci. J Clin Microbiol 1990;28:426–429.Google Scholar
11.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
12.Goldmann, DA, Freeman, J, Durbin, WA Jr. Nosocomial infection and death in a neonatal intensive care unit. J Infect Dis 1983;147:635–641.Google Scholar
13.Hemming, VG, Overall, JC Jr, Britt, MR. Nosocomial infections in a newborn intensive care unit: results of forty-one months of surveillance. N Engl J Med 1976;294:1310–1316.Google Scholar
14.Donowitz, LG. Nosocomial infection in neonatal intensive care units. Am J Infect Control 1989;17:250–257.CrossRefGoogle ScholarPubMed
15.Drews, MB, Ludwig, AC, Leititis, JU, Daschner, FD. Low birth weight and nosocomial infection of neonates in a neonatal intensive care unit. J Hosp Infect 1995;30:65–72.Google Scholar
16.Villari, P, Lacuzio, L, Torre, I, Scarcella, A. Molecular epidemiology as an effective tool in the surveillance of infections in the neonatal intensive care unit. J Infect 1998;37:274–281.Google Scholar
17.Freeman, J, Rosner, BA, McGowan, JE. Adverse effects of nosocomial infection. J Infect Dis 1979;140:732–740.Google Scholar
18.Spengler, RF, Greenough, WB. Hospital cost and mortality attributed to nosocomial bacteremias. JAMA 1978;240:2455–2458.Google Scholar
19.Schaberg, DR, Tompkins, LS, Falkow, S. Use of agarose gel electrophoresis of plasmid deoxyribonucleic acid to fingerprint gram-negative bacilli. J Clin Microbiol 1981;13:1105–1108.Google Scholar
20.Hartstein, Al, Chetchotisakd, P, Phelps, C, Lemonte, AM. Typing of sequential bacterial isolates by pulsed-field gel electrophoresis. Diagn Microbiol Infect Dis 1995;22:309–314.Google Scholar
21.Farrar, WE Jr. Molecular analysis of plasmids in epidemiologic investigation. J Infect Dis 1983;148:1–6.Google Scholar
22.Markowitz, SM, Smith, SM, Williams, DS. Retrospective analysis of plasmid patterns in a study of burn unit outbreaks of infection due to Enterobacter cloacae. J Infect Dis 1983;148:18–23.Google Scholar