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Enterobacter cloacae colonisation and infection in a neonatal intensive care unit: retrospective investigation of preventive measures implemented after a multiclonal outbreak

Authors
  • Ferry, Alexandrine1
  • Plaisant, Frank1
  • Ginevra, Christophe2
  • Dumont, Yann2
  • Grando, Jacqueline2
  • Claris, Olivier1, 3
  • Vandenesch, François2, 4
  • Butin, Marine1, 4
  • 1 Service de Néonatologie et Réanimation Néonatale, Hôpital Femme Mère 59 Boulevard Pinel, Bron, 69500, France , Bron (France)
  • 2 Centre National de Référence des Staphylocoques, Groupement Hospitalier Nord, Lyon, France , Lyon (France)
  • 3 Université Claude Bernard, Villeurbanne, EA, 4129, France , Villeurbanne (France)
  • 4 Université de Lyon, Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1; CNRS, UMR5308, Lyon, France , Lyon (France)
Type
Published Article
Journal
BMC Infectious Diseases
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Sep 17, 2020
Volume
20
Issue
1
Identifiers
DOI: 10.1186/s12879-020-05406-8
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundEnterobacter cloacae species is responsible for nosocomial outbreaks in vulnerable patients in neonatal intensive care units (NICU). The environment can constitute the reservoir and source of infection in NICUs. Herein we report the impact of preventive measures implemented after an Enterobacter cloacae outbreak inside a NICU.MethodsThis retrospective study was conducted in one level 3 NICU in Lyon, France, over a 6 year-period (2012–2018). After an outbreak of Enterobacter cloacae infections in hospitalized neonates in 2013, several measures were implemented including intensive biocleaning and education of medical staff. Clinical and microbiological characteristics of infected patients and evolution of colonization/infection with Enterobacter spp. in this NICU were retrieved. Moreover, whole genome sequencing was performed on 6 outbreak strains.ResultsEnterobacter spp. was isolated in 469 patients and 30 patients developed an infection including 2 meningitis and 12 fatal cases. Preventive measures and education of medical staff were not associated with a significant decrease in patient colonisation but led to a persistent decreased use of cephalosporin in the NICU. Infection strains were genetically diverse, supporting the hypothesis of multiple hygiene defects rather than the diffusion of a single clone.ConclusionsGrouped cases of infections inside one setting are not necessarily related to a single-clone outbreak and could reveal other environmental and organisational problematics. The fight against implementation and transmission of Enterobacter spp. in NICUs remains a major challenge.

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