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Original Research

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Outbreak of nosocomial bacteremias, caused by Enterobacter gergoviae and Enterobacter aerogenes, in the neonatal intensive care unit, case - control study

  • NATAŠA BOBAN1
  • ANA JERONČIĆ2
  • VOLGA PUNDA-POLIĆ3

1,Department of Clinical Epidemiology University Hospital Split and University of Split School of Medicine

2,Department for Research in Biomedicine and Health University of Split School of Medicine

3,Department of Clinical Microbiology University Hospital Split and University of Split School of Medicine

DOI: 10.22514/SV61.052011.4 Vol.6,Issue 1,May 2011 pp.27-32

Published: 02 May 2011

*Corresponding Author(s): NATAŠA BOBAN E-mail: natasa.boban@st.htnet.hr

Abstract

In this case-control study we describe epidemiological characteristics and evaluate risk factors for bacteremias caused by a rare human pathogen Enterobacter gergoviae, and Enterobacter aerogenes, among neonates in the intensive care unit, under conditions of nosocomial outbreak.

Crude rate of bacteremias was 16 per 1000 admissions. Bacteremias most commonly occurred between 7th to 30th day of hospitalization and were 1.9 times more frequent in males than females. The following risk factors were significantly asso-ciated with the development of bacteremias: a) colonization or infection of neonates prior to the onset of bacteremia with Enterobacter spp. (OR=3.4, 95%CI=1.2-9.9) or non-Enterobacter spp. (OR=7.9, 95%CI=1,2-52.5); b) use of antimicrobial drugs most notably ceftazidime (OR = 7.8, 95% CI = 1.6.-38.6), or amikacin (OR = 7.5, 95% CI = 2.8-19.9); and c) invasive interventions: mechanical ventilation (OR = 4.7, 95% CI = 1.6-13.5), umbilical catheterization (OR = 3.1, 95% CI = 1.1-13.3), or nasogastric tube insertion (OR = 3.8, 95% CI = 1.8-8). These results show that some previously described risk factors for developing Enterobacter bacteremia were equally applicable in the case of Enterobacter gergoviae infections. In addition, the report represents an important contribution to establishing E. gergoviae as a relevant human pathogen with epidemiological potential, as it is the first case-control report in the region and one of a few in the world, analyzing outbreaks of bacteremias in the neonatal intensice care unit (ICU) caused by E. gergoviae.

Keywords

neonatal intensive care unit, bacteremia, Enterobacter ger-goviae, Enterobacter aerogenes, risk factors

Cite and Share

NATAŠA BOBAN,ANA JERONČIĆ,VOLGA PUNDA-POLIĆ. Outbreak of nosocomial bacteremias, caused by Enterobacter gergoviae and Enterobacter aerogenes, in the neonatal intensive care unit, case - control study. Signa Vitae. 2011. 6(1);27-32.

References

1. Sanders WE, Sanders CC. Enterobacter spp.: Pathogens poised to flourish at the turn of the century. Clin Microbiol Rev 1997;10:220-41.

2. Falkiner FR. Enterobacter in hospital. J Hosp Infect 1992;20:137-40.

3. Ronveaux O, de Gheldre I, Glupcynski Y, Struelens M, de Mol P. Emergence of Enterobacter aerogenes as a major antibiotic-resistant nosocomial pathogen in Belgian hospitals. Clin Microbiol Infect 1999;5:622-7.

4. Al Ansari, McNamara EB, Cunney RJ, Flynn MA, Smyth EG. Experience with Enterobacter bacteremia in a Dublin teaching hospital. J Hosp Infect 1994;27:69-72.

5. Acolet D, Ahmet Z, Houang E, Hurley R, Kaufmann ME. Enterobacter cloacae in a neonatal intensive care unit: account of an outbreak and its relationship to use of third generation cephalosporins. J Hosp Infect 1994;28:273-86.

6. Xu XF, Mia XL, Chen Z, Shi LP, Du LZ. Clinical characteristics of nosocomial infections in neonatal intensive care unit in eastern China. J Perinat Med 2010;38(4):431-7.

7. Chang EP, Chiang DH, Lin ML, Chen TL, Wang FD, Liu CY. Clinical characteristics and predictors of mortality in patients with Enterobacter aerogenes bacteremia. J Microbiol Immunol Infect 2009;42(4):329-35.

8. Gastmeir P, Andrea Loui A, Stamm-Balderjahn S, Hansen S, Zuchneid I, Sohr D, et al. Outbreaks in NICU-They are not like others. Am J Infect Control 2007;35(3):172-6.

9. Canton R, Oliver A, Coque TM, Varela MdC, Perez-Diaz JC, Baquero F. Epidemiology of extended-spectrum beta-lactamase-producing Enterobacter isolates in a spanish hospital during 12-year period. J Clin Microbiol 2002;40(4)1237-43.

10. Ho PL, Shek RH, Chow KH, Duan RS, Mak GC, Lai EL, et al. Detection and characterisation of extended-spectrum beta-lactamases among bloodstream isolates of Enterobacter spp. in Hong Kong, 2000-2002. J Antimicrob Chemoter 2005;55(3):326-32.

11. Stock I, Wiedemann B. Natural antibiotic susceptibility of Enterobacter amnigenus, Enterobacter cancerogenus, Enterobacter gergoviae and Enterobacter sakazakii strains. Clin Microbiol infect 2002;8(9):564-78.

12. Pittet D. Nosocomial bloodstream infections. In: Wenzel RP, ed. Prevention and control of nosocomial infections. Baltimore: Williams&Wilkins; 1995. pp. 711-70.

13. Gallagher PG. Enterobacter bacteremia in pediatric patients. Rev Infect Dis 1990;12:808-12.

14. Andresen J, Asmar BI, Dajani AS. Increasing Enterobacter bacteremia in pediatric patients. Pediatr Infect Dis J 1994;13:787-92.

15. Gaynes RP, Edwards JR, William R, Culver DH, Tolson JS, Martone WJ. Nosocomial infections among neonates in high–risk nurseries in the United States. Pediatrics 1996;98:357-61.

16. Liowal V, Kumar A, Gupta P, Gomber S, Ramachandran VG. Enterobacter aerogenes outbreak in a neonatal intensive care unit. Pediatr Int 1999;41:157-61.

17. Fok TF, Lee CH, Wong EM, Lyon DJ, Wong W, Ng PC, et al. Risk factors for Enterobacter septicemia in a neonatal unit: case-control study. Clin Infect Dis 1998;27(5):1204-9.

18. 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.

19. de Man P, Verhoeven BAN, Verbrugh HA, Vos MC, van der Anker JN. An antibiotic policy to prevent emergence to resistant bacili. Lancet 2000;355:973-8.

20. Dalben M, Varkulja G, Basso M, Krebs VL, Gibelli MA, van der Heijden I, et al. Investigation of an outbreak of Enterobacter cloacae in a neonatal unit and review of the literature. J Hosp Inf 2008;70(1)7-14.

21. Yu WL, Cheng HS, Lin HC, Peng CT, Tsai CH. Outbreak investigation of nosocomial enterobacter cloacae bacteremia in neonatal intensive care unit. Scand J Infect Dis 2000;32(3):293-8.

22. Moore DL. Nosocomial infections in newborn nurseries and neonatal intensive care units. In: Mayhall CG, ed. Hospital epidemiology and infection control. Baltimore: Williams & Wilkins; 1996. pp. 535-64.

23. Carlier E, Piagnerelli M, Lejeune P, de Gheldre Y, Struelens M, Glupczynski Y. Investigation of an outbreak of multiresistant Enterobacter aerogenes infection in an intensive care unit. Critical Care 1997;1(Suppl 1):P035

24. Chen KJ, Yang KJ, Sun CC, Yeung L. Traumatic endophtalmitis caused by Enterococcus raffinosus and Enterobacter gergoviae. J Med Microbiol 2009;58:526-8.

25. Ganeswire R, Thong KL, Puthucheary SD. Nosocomial outbreak of Enterobacter gergoviae bacteremia in a neonatal intensive care unit. J Hosp Inf 2003;53(4):292-6.

26. Richard C, Joly B, Sirot J, Stoleru GH, Popoff M. Etude de souches de Enterobacter apartenant a un groupe particulier proche de E. aerogenes. Ann Inst Pasteur 1976;127A:545-8.

27. Brenner DJ, Richard C, Steigerwalt AG, Asbury MA, Mandel M. Enterobacter gergoviae sp. nov.: a new species of Enterobacteriaceae found in clinical speciments and the enviroment. Int J Syst Bacteriol 1980;30:1-6.

28. Rojo D, Pinedo A, Clavijo E, Garcia-Rodrigez, Garcia V. Analysis of risk factors associated with nosocomial bacteremias. J Hosp Infect 1999;42:135-41.

29. Toltzis P, Hoyden C, Spinner-Block S, Salvatot AE, Rice LB. Factors that predict preexisting colonization with antibiotic resistant gram-negative bacilli in patients admitted to a pediatric intensive care unit. Pediatrics 1999;103:719-23.

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