Environmental Surveillance Cultures Research Articles

Ralstonia mannitolilytica outbreak in a day care oncology ward

Aim: Ralstonia mannitolilytica species, an opportunistic pathogen prevalent in moist environmental conditions has been known to cause outbreaks in health care associated institutes. It has been linked to contaminated equipment, antiseptics and other medications. This article deals with an outbreak in Day care ward which caters primarily to oncology patients. Methodology: Blood cultures of febrile patients who had received chemotherapy were evaluated. Environmental surveillance cultures were undertaken to investigate the outbreak. Results: Six patients who presented with fever grew R. mannitolilytica in their blood cultures exhibiting the differential time to positivity. The chemo ports were removed and appropriate antibiotics based on the sensitivity profile were administered. The patients responded to these measures. Environmental surveillance cultures were negative. Conclusion: Accurate identification of nonfermenters in blood cultures is essential for appropriate management of patients. The isolation of organisms such as Ralstonia species could indicate a breach in sterility calling forth appropriate investigations. Infection control training needs to be reinforced regularly to prevent the occurrence of healthcare associated infections.

Co-production of OXA-48 and NDM-1 Carbapenemases in Providencia rettgeri: the first report

Our country is the epicenter of the OXA-48-like carbapenemase-producing Klebsiella and Escherichia coli; and in the recent years, the concern has been increasing due to both spreading of this resistance to other members of Enterobacteriaceae family and acquiring other carbapenemases by the OXA-48-producing strains. In this study, OXA-48 and NDM-1 co-production was presented in Providencia rettgeri. Two P.rettgeri strains that were resistant to all antimicrobials except colistin and tigecyclin, were isolated from two patients in the burn unit of our hospital, including one from the urine sample of a 68 years female in April 2017, and the other from a burn wound swab of a 35 years old male, in November 2017. Minimal inhibitory concentrations (MICs) of the isolates for imipenem and meropenem were measured as ≥ 32 µg/ml; and for colistin and tigecyclin were 1 ve 0.5 µg/ml, respectively. Multiplex PCR analysis showed that both strains were carrying blaOXA-48 and blaNDM-1 carbapenemases, and blaTEM extended spectrum beta-lactamase genes. By using DNA sequence analysis, the TEM gene was typed as blaTEM-1. The Pulsed Field Gel Electrophoresis (PFGE) analysis indicated that these two strains which were consecutively isolated from two different patients in a single unit within about seven months were genetically indistinguishable. No significant data that could explain the spread of these isolates was obtained from our retrospective analysis of the medical records including the results of environmental surveillance cultures, and patients' history. Nevertheless, hospital infection control committee enforced the infection control measures in that unit, and no further isolation was observed within three months period following the last isolation, neither from environmental nor from clinical samples. With this study, it was emphasized that the co-production of OXA-48 and NDM-1 carbapenemases which was reported from only three Enterobacteriaceae species up to date was ongoing for spreading to other species by using horizontal route, and also showing a potential to be a growing problem in the hospitals, by clonal expansion (vertical route). Effectively using of the molecular epidemiological methods will provide useful data to better understand the transmission dynamics of such rare, but problematic species in hospitals.

Polymerase chain reaction-based open reading frame typing (POT) method analysis for a methicillin-resistant Staphylococcus aureus (MRSA) outbreak through breast-feeding in the neonatal intensive care unit

IntroductionThe route of methicillin-resistant Staphylococcus aureus (MRSA) transmission in the neonatal intensive care unit (NICU) is not clearly explained. We investigate an MRSA outbreak involving five babies in the NICU. The molecular investigation using polymerase chain reaction-based open reading frame typing (POT) method was performed. Presentation of outbreakA MRSA outbreak occurred in a six-bed NICU affecting 5 babies. Within 13 days of the emergence of index case, all five babies including triplets and other two babies were found to colonize MRSA by the active surveillance culture. Environmental surveillance cultures revealed that the preserved breast milk provided by the triplets' mother was the only item in the NICU that was positive for MRSA. The mother had a bite wound on the nipples, and the breast milk was not pasteurized. The POT method revealed that MRSA strains detected from the triplets, the breast milk, and the other baby who was fed the triplets' mother's milk were genetically identical (POT index: 106-247-33). The all strains of MRSA carried Staphylococcal cassette chromosome mec (SCCmec) IV and had good susceptibility for the non-ß-lactam antimicrobial agents, suggesting the strains were community-acquired MRSA. ConclusionsThe mother’s milk contaminated with community-origin MRSA is serving as the reservoir of MRSA and one of the sources of MRSA outbreaks in the NICU. It is important to closely monitor the condition of the mothers of the children in the NICU. Pasteurization of breast milk should be considered when the skin on the nipple is broken.

Candida albicans outbreak associated with total parenteral nutrition in the neonatal unit

Background: The most frequently isolated fungi in patients using TPN belongs to the Candida genus. Various infections including venous catheter infections, fungemia, endocarditis and ophthalmitis may be encountered. Objective: Upon growth of Candida in the blood cultures from the pediatric (neonatal) unit of our hospital, a surveillance was performed in this unit and involving the health care workers. Clonal relationships of the isolates were investigated with molecular tests. Methods: Blood samples obtained from the patients in pediatric neonatal unit were studied with automatized blood culture [BacT/Alert (Bio Mérioux, France)]. Yeast isolates from environmental surveillance cultures (TPN solutions, hands of healthcare personnel, étagère, etc) and patients were identified as C. albicans with conventional methods and ID 32 C and ATBTM Fungus 3 (Biomerieux, France) kits. Clonal similarity was determined by using AP-PCR as initial method and we have also typified all strains by the method of REP-PCR (diversilab system,bioMérieux). Finally; Pulsed Field Gel Electrophoresis (PFGE) was used for confirmation. Results:C. albicans was isolated in blood cultures of seven patients. Similar antifungal susceptibility patterns were observed in all isolates. AP-PCR and REP-PCR showed that the C. albicans isolates grown in the TPN solution and from the patients’ blood cultures were clonally same strains. PFGE analysis further confirmed this clonality. Conclusion: According to results of the molecular methods, we thought that a C. albicans outbreak had occurred in the neonatal pediatric unit, due to contamination of TPN solution.

Comparative efficacies of disinfectants against bacteria causing healthcare-associated infections

spread of pathogens to other patients or surfaces. Therefore cleaning and disinfection are paramount for keeping the environment and fomites safe for animals andhumans in ahospital and field environments. Studies in humans and veterinary settings have shown that contaminated environment and fomites (stethoscopes, thermometers, etc.) are routinely found, thus posing a risk for disease transmission. Furthermore routine cleaning and disinfection has been shown to be effective in decreasing the bioburden on environmental surfaces, thus decreasing the chances of disease transmission. Practices such as improved education and training, checklists to assure that all surfaces and equipment/devises are treated and assessment of environmental cleanliness with feedback to the environmental service worker have been shown in human medicine to improve frequency of adequate cleaning by 71 to 77%. Practices like these, with the added environmental surveillance cultures for Salmonella spp.were instituted by the author with success in the past in both the field and hospital environments. Even though studies have shown that environmental cleaning and disinfection reduces pathogen loads, thesemeasures should be complementedbyother interventions that strengthen and complement it. For example monitoringof Salmonella shedderswill enhanced infection control practices byperformingamore thorough cleaninganddisinfection of high risk areas. Moreover biosecurity education of personnel involved with animal care would increase engagement and compliance, thus strengthening infectious control measures.

944Outbreak of Colistin-Resistant Acinetobacter baumannii in Intensive Care Units in Detroit, Michigan

Background: A. baumannii is commonly recognized as an emerging multi-drug resistant (MDR) organism frequently impervious to majority of the commonly prescribed antibiotics. Colistin is one of the few therapeutic agents which possess activity against this pathogen, and its use has dramatically increased. As a result, colistin resistance is increasingly reported among A. baumannii and presents a unique challenge. Methods: A cluster of colistin-resistant A. baumannii cases at Detroit Receiving Hospital were identified from May 1st, 2013 to October 31st, 2013. Colistin resistance was defined as an MIC of >2 μg/ml (E-test). Epidemiologic data for these cases were collected and isolates assayed for clonality with Diversilab rep-PCR and multi-locus sequence typing (ST). Results: 11 cases were identified. The mean age of the patients was 48.8 years (range 17-76) and 10 (91%) resided in one of two intensive care units. All patients were treated with broad spectrum antimicrobials (but not colistin) prior to isolation of the colistin-resistant isolate. 9 (82%) patients were mechanically ventilated and the pathogen was detected from sputum specimen in 8 (73%) of patients. Other features frequently identified in these cases were the use of glucometer (73%) and tube feeds (82%). Colistin MIC ranged from 3-32. Environmental surveillance cultures were performed, but only one specimen was positive for the same organism. Genotyping was performed on 5 patient isolates which revealed 95% similarity between strains (Figure 1) and all isolates were ST281. In order to contain the outbreak, optimal infection prevention practices were reinforced, active surveillance screening of high risk patients implemented, with presumptive contact isolation. Conclusion: To our knowledge this is the first reported outbreak of colistin-resistant A. baumannii in United States. The hands of healthcare workers and environmental reservoirs are hypothesized to be the source of the outbreak. We observed a wide range of colistin MICs among outbreak strains, possibly due to 1) the emergence of heteroresistance or 2) differences in the population structure. A case-control study will help to further help delineate the cause of the outbreak. OXA23

The role of leech water sampling in choice of prophylactic antibiotics in medical leech therapy

Medical leech therapy (MLT) with Hirudo medicinalis is well established as a treatment for venous congestion of tissue flaps, grafts, and replants. Unfortunately, this treatment is associated with surgical site infections with bacterial species, most commonly Aeromonas hydrophila, which is an obligate symbiot of H. medicinalis. For this reason, prophylactic antibiotics are recommended in the setting of MLT. After culturing Aeromonashydrophila resistant to ciprofloxacin from a tissue specimen from a patient with a failed replant of three digits post-MLT, we performed environmental surveillance cultures and antibiotic susceptibility testing on water collected from leech tanks. This surveillance was performed twice weekly for 2.5 months. Fourteen surveillance cultures demonstrated 21 isolates of Aeromonas species, 71.4% of which were ciprofloxacin susceptible. All isolates were sulfamethoxazole-trimethoprim (SXT) susceptible. The prophylactic antibiotic regimen of choice for leech therapy at our institution is SXT, with culture of tank water to refine antimicrobial choice if necessary. This study demonstrates the importance of regular surveillance to detect resistant Aeromonas species in medical leeches; however optimal practice has not been established.

Prior Environmental Contamination Increases the Risk of Acquisition of Vancomycin-Resistant Enterococci

Patients colonized with vancomycin-resistant enterococci (VRE) frequently contaminate their environment, but the environmental role of VRE transmission remains controversial. During a 14-month study in 2 intensive care units, weekly environmental and twice-weekly patient surveillance cultures were obtained. VRE acquisition was defined as a positive culture result >48 h after admission. To determine risk factors for VRE acquisition, Cox proportional hazards models using time-dependent covariates for colonization pressure and antibiotic exposure were examined. Of 1330 intensive care unit admissions, 638 patients were at risk for acquisition, and 50 patients (8%) acquired VRE. Factors associated with VRE acquisition included average colonization pressure (hazard ratio [HR], 1.4 per 10% increase; 95% confidence interval [CI], 1.2-1.8), mean number of antibiotics (HR, 1.7 per additional antibiotic; 95% CI, 1.2-2.5), leukemia (HR, 3.1; 95% CI, 1.2-7.8), a VRE-colonized prior room occupant (HR, 3.1; 95% CI, 1.6-5.8), any VRE-colonized room occupants within the previous 2 weeks (HR, 2.5; 95% CI, 1.3-4.8), and previous positive room culture results (HR, 3.4; 95% CI, 1.2-9.6). In separate multivariable analyses, a VRE-colonized prior room occupant (HR, 3.8; 95% CI, 2.0-7.4), any VRE-colonized room occupants within the previous 2 weeks (HR, 2.7; 95% CI, 1.4-5.3), and previous positive room culture results (HR, 4.4; 95% CI, 1.5-12.8) remained independent predictors of VRE acquisition, adjusted for colonization pressure and antibiotic exposure. We found that prior room contamination, whether measured via environmental cultures or prior room occupancy by VRE-colonized patients, was highly predictive of VRE acquisition. Increased attention to environmental disinfection is warranted.

Bronchoscope reprocessing and infection prevention and control. Bronchoscopy-specific guidelines are needed

Chest 2004;125:307–314. Srinivasan A, Wolfeenden LL, Song X, Perl TM, Haponik EF. Study Summary: In this study, the investigators invited practicing bronchoscopists to complete a 22-question survey addressing infection control issues related to bronchoscopy. The survey was distributed to the participants in 2 bronchoscopy courses. Of 46 completed surveys included in the study, 12 (26%) were completed by medical directors of bronchoscopy suites and 34 (74%) were completed by attending bronchoscopists. On average, the participants performed 19 bronchoscopies per month. Overall, 65% of respondents were not aware of any national reprocessing guidelines. Medical directors of the bronchoscopy suites (45%) were no more aware of reprocessing guidelines than the attending bronchoscopists (31%). Eighteen (39%) participants were not aware of the reprocessing method in their own institution. Seventy-eight percent of respondents did not know local practices for at least 1 of the reprocessing questions. There were considerable variations in the local infection control practices. Only 46% of respondents reported keeping the record of using specific bronchoscope in an individual case. Thirty-two percent reported surveillance of bronchoscopy cultures, most commonly by infection control personnel. Thirty percent reported culturing bronchoscope as a routine infection control measure. Almost an equal proportion of respondents did know whether bronchoscopy culture surveillance is done in their institution. The authors concluded that experienced bronchoscopists are unfamiliar with national guidelines and local bronchoscope reprocessing practices. Comments: A contaminated bronchoscope could act as a vector for infection with serious clinical implications (N Engl J Med 2003;348:214–220, N Engl J Med 2003;348:221–227). The exact magnitude of this problem is unknown, partly as a result of difficulties in establishing a cause-and-effect relation between bronchoscopy and transmission of infection and partly as a result of lack of surveillance mechanism in most bronchoscopy suites. There are data to indicate that breaches from reprocessing guidelines are common (Am J Med 1992;92:257–261, Thorax 1997;52:709–713). The current study provides an important explanation for this problem; there is a general lack of awareness and familiarity with infection control recommendations, bronchoscope reprocessing guidelines, and local practices followed in individual bronchoscopy suites. The study raises several important issues. If directors and experienced bronchoscopists know so little about the reprocessing practices and guidelines, how much do fellows in training and bronchoscopy assistants know about this topic! The survey highlights marked variations in local reprocessing and surveillance practices. Less than half of the respondents reported keeping records of the specific bronchoscope used in an individual case. This information is critical for a subsequent epidemiologic investigation in an outbreak situation. Less than one third of respondents reported surveillance of bronchoscopy culture results in their institution. This kind of surveillance provides an important opportunity for early detection of an outbreak. On the contrary, 30% of respondents reported routine culture of bronchoscope, which is unnecessary as environmental surveillance cultures, including those from bronchoscopes are not required on a routine basis. The results from this study reinforce the need for all bronchoscopy personnel, including bronchoscopists, bronchoscopy assistants, nurses, and pulmonary fellows, to become familiar with the infection control issues surrounding bronchoscopy. Several publications, including a recent review, address this subject in considerable details (Am J Respir Crit Care Med 2003;167:1050–1056). The Association for Professionals in Infection control and Epidemiology Inc. (APIC) has published comprehensive guidelines for infection prevention and control in the endoscopy suite (AJIC Am J Infect Control 2000;28:138–155). These guidelines provide thorough and state-of-the-art information on recommended reprocessing procedures. Similar bronchoscopy-specific guidelines are needed in pulmonary literature. Several limitations of this study should be noted. The sample size was very small. Several critical questions pertaining to reprocessing steps were not asked. Some questions were unclear and could be interpreted in more than 1 way. The survey did not inquire who trains the personnel in charge of reprocessing bronchoscopes and how often such training is reinforced. Despite these limitations, the central message from this paper is absolutely critical to everyday practice of bronchoscopy and patient safety. It should serve as a wakeup call for all who are involved in organizing and implementing infection control policies and procedures in their bronchoscopy suites.

The Importance of Transferring Accountability for Infection Control Practices to the Direct Care Providers: Lessons Learned from a Neonatal Intensive Care Unit Outbreak of Pseudomonas aeruginosa

BACKGROUND: An investigation was initiated when the microbiology laboratory notified Infection Control (IC) of an increase in Pseudomonas aeruginosa (PA) from our 50-bed level-III neonatal intensive care unit (NICU) in a 5-week period. METHODS: IC performed record reviews of all PA patients, verified direct care provider (DCP) practices by observation and questioning the staff, reviewed written practice guidelines for the NICU and respiratory staff, and performed a variety of patient and environmental surveillance cultures. All PA isolates were submitted for strain characterization by cell wall fatty acid analysis. RESULTS: Review of the NICU microbiology data disclosed that from January 1–September 30, 2003, there had been only four episodic cases of PA. From October 8–November 12, 2003, six patients were identified; four had bloodstream infection (BSI) with three deaths. Surveillance cultures on December 2, 2003, identified a seventh patient. All patients with PA overlapped in their hospital stays and four of seven (4/7) were in the same nursery. All PA isolates had the same antibiogram and were confirmed to be a single strain. All environmental cultures were no growth. The results of the investigation were shared with the NICU faculty and staff. Guidelines were developed to control the outbreak. Inservice was provided to all shifts by IC and Staff Development for the NICU. IC emphasized the importance of holding all DCPs accountable for adherence to the guidelines. The NICU staff was empowered to demand compliance by all consult and ancillary service staff. IC performed weekly surveillance cultures of the patients. Since December 2, 2003, there have been no new patients with PA. CONCLUSION: We identified a single strain of PA causing an outbreak of cross infection in the NICU. Prevention of cross infection requires compliance with IC practices. Multiple disciplines provide specific skills to these patients, and the frequent contacts that occur between the patient and the DCP increases the risk of cross infection. We believe that transferring accountability for IC practices to the DCP was significant in controlling the outbreak.

Outbreak of vancomycin-resistant Enterococcus faecium in a neonatal intensive care unit.

An outbreak of vancomycin-resistant Enterococcus faecium involving 28 infants in a neonatal intensive care unit was observed. Successful control of the outbreak was achieved following use of patient and staff cohorting, contact isolation precautions, patient and environmental surveillance cultures, environmental decontamination, molecular typing, introduction of an alcohol-based hand disinfectant, and decreased use of vancomycin.

Legionella in water distribution systems

Regular culturing of distribution system samples is the key to successful disinfection.Legionnaires' disease arises from the presence of Legionella in water systems. Legionella can be found within biofilms throughout the entire water distribution system. Control measures such as copper‐silver ionization, superheat‐and‐flush procedures, ultraviolet light, instantaneous heating systems, and hyperchlorination have been applied with variable success. Specific approaches, advantages, disadvantages, and costs of each method are reviewed. Many approaches commonly recommended by public health authorities have not been scientifically validated. Results from routine environmental surveillance cultures for Legionella are the critical component for rational decision‐making.

An outbreak of vancomycin-resistant Enterococcus faecium in liver transplant recipients

Vancomycin-resistant Enterococcus faecium (VREF) has become a significant nosocomial pathogen for immunosuppressed patients. During a 5-month period in 1993, 8 cases of invasive infection with VREF (7 with bacteremia) were identified in liver transplant recipients, half of whom were adults. Epidemiology and microbiology studies were designed to identify the source and to determine the risk factors for this infection. Overall mortality was 50% (3 adults and 1 child). Mortality in bacteremic patients was 57%. A case-control study showed that cases were more likely to have been treated with a third-generation cephalosporin or vancomycin and to have undergone more than four biliary tract procedures. Environmental surveillance cultures yielded only one VREF isolate from a rectal temperature probe, but this device was used in only 2 of the cases. Cultures from all surgery and radiology suites were negative. All VREF isolates were genotyped by contour-clamped homogenous electric field electrophoresis of chromosomal DNA restriction fragments. These studies showed that a single clone was responsible for the outbreak, although other clones could be detected in the hospital. After implementing strict contact isolation on the liver transplant unit, only 1 additional patient with VREF was identified during this outbreak. In conclusion, it was found that antibiotic use and biliary tract manipulation were risk factors for developing invasive infections with VREF after liver transplantation. Optimal treatment is still unclear but most likely includes a combination of two or more antibiotics. Prompt institution of infection control measures can preclude rapid spread of this nosocomial pathogen. (Liver Transpl Surg 1997 Nov;3(6):586-90)

An outbreak of vancomycin-resistant Enterococcus faecium in liver transplant recipients

Vancomycin-resistant Enterococcus faecium (VREF) has become a significant nosocomial pathogen for immunosuppressed patients. During a 5-month period in 1993, 8 cases of invasive infection with VREF (7 with bacteremia) were identified in liver transplant recipients, half of whom were adults. Epidemiology and microbiology studies were designed to identify the source and to determine the risk factors for this infection. Overall mortality was 50% (3 adults and 1 child). Mortality in bacteremic patients was 57%. A case-control study showed that cases were more likely to have been treated with a third-generation cephalosporin or vancomycin and to have undergone more than four biliary tract procedures. Environmental surveillance cultures yielded only one VREF isolate from a rectal temperature probe, but this device was used in only 2 of the cases. Cultures from all surgery and radiology suites were negative. All VREF isolates were genotyped by contour-clamped homogenous electric field electrophoresis of chromosomal DNA restriction fragments. These studies showed that a single clone was responsible for the outbreak, although other clones could be detected in the hospital. After implementing strict contact isolation on the liver transplant unit, only 1 additional patient with VREF was identified during this outbreak. In conclusion, it was found that antibiotic use and biliary tract manipulation were risk factors for developing invasive infections with VREF after liver transplantation. Optimal treatment is still unclear but most likely includes a combination of two or more antibiotics. Prompt institution of infection control measures can preclude rapid spread of this nosocomial pathogen.

Clinical and molecular epidemiology of acinetobacter infections sensitive only to polymyxin B and sulbactam

SummaryA nosocomial outbreak of infections due to imipenem-resistant Acinetobacter baumannii occurred in a New York hospital after increased use of imipenem for cephalosporin-resistant klebsiella infections.We identified all A baumannii isolates over 12 months, reviewed corresponding patient records, and compared strains with different antibiotic susceptibility patterns by restriction endonuclease analysis. Environmental surveillance cultures were done before and after institution of control measures. 59 patients harboured imipenem-resistant A baumannii, and 18 were infected. Isolates from patients were resistant to all routinely tested antibiotics, including imipenem. Further studies showed susceptibility to polymyxin B and sulbactam. These isolates were identical by restriction endonuclease analysis to A baumannii isolates susceptible to imipenem alone, or to imipenem and amikacin, but differed from broadly susceptible isolates. Surveillance cultures showed hand and environmental colonisation by imipenem-resistant strains. Infection and colonisation were eliminated by intensive infection control measures, and irrigation of wounds with polymyxin B.Increased use of imipenem against cephalosporin-resistant klebsiella may lead to imipenem resistance among other species, particularly acinetobacter. Such resistance appears to derive from a prior multi-resistant clone, in contrast to one which retains susceptibility to several antibiotics.

Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers.

To describe an epidemic of vancomycin-resistant Enterococcus faecium causing bacteremia and bacteriuria, to identify the source of infection, to delineate risk factors associated with acquisition of the organism, and to determine antibiotic sensitivities for the organism. Investigation of an epidemic, including a case-control study. Medical-surgical intensive care unit and ward in a university medical center. Nine patients infected or colonized with vancomycin-resistant Enterococcus faecium and 20 noninfected controls. Clinical data, environmental surveillance cultures, and in-vitro microbiologic studies. Colonization or infection by vancomycin-resistant E. faecium was associated with an increased duration of treatment with ceftazidime, 13.2 compared with 4.6 days, and a greater number of nonisolated days of hospitalization in the intensive care unit, 19.9 compared with 6.4 days for infected and noninfected patients, respectively (P less than 0.05). Environmental surveillance cultures recovered the organism repeatedly from the rectal probe handles of three electronic thermometers used exclusively on nonisolated patients in the intensive care unit. Restriction endonuclease analysis of plasmid DNA showed that all clinical and environmental isolates were identical. Infection control measures, including isolation of colonized or infected patients and removal of the rectal thermometer probes suspected to be responsible for transmission, resulted in termination of the outbreak. In-vitro, time-kill studies showed that the combination of ciprofloxacin, rifampin, and gentamicin resulted in bactericidal activity against the organism. This nosocomial outbreak of infection due to a highly vancomycin-resistant strain of Enterococcus is the first epidemic in which an electronic thermometer has been implicated as the vehicle of transmission for an infectious agent.

Flavobacterium meningosepticum infection in a neonatal ward

An outbreak of infections due to Flavobacterium meningosepticum type C in a neonatal intensive care unit is described. During a period of two weeks, two infants developed meningitis and a third was colonized in the respiratory tract and had transient bacteremia. The two meningitis patients were treated with clindamycin, rifampicin and cefotaxime systemically, plus rifampicin intraventricularly. Bacteriological eradication was achieved within 48 h, and both infants recovered from the meningitis without apparent neurological sequelae; however, one infant died two months later of unrelated causes. Environmental surveillance cultures failed to demonstrate a reservoir for the epidemic strain, but other Flavobacterium strains were recovered. Two clinically healthy infants were found to be colonized in the nasopharynx with strains that were extremely difficult to differentiate phenotypically from the epidemic strain. Extensive characterization of strains is necessary in order to differentiate between strains and subsequently to determine a certain source of infection.