INTERREPEAT FINGERPRINTING OF 3RD-GENERATION CEPHALOSPORIN-RESISTANT ENTEROBACTER-CLOACAE ISOLATED DURING AN OUTBREAK IN A NEONATAL INTENSIVE-CARE-UNIT
Pe. Verweij et al., INTERREPEAT FINGERPRINTING OF 3RD-GENERATION CEPHALOSPORIN-RESISTANT ENTEROBACTER-CLOACAE ISOLATED DURING AN OUTBREAK IN A NEONATAL INTENSIVE-CARE-UNIT, Infection control and hospital epidemiology, 16(1), 1995, pp. 25-29
OBJECTIVE: To investigate an outbreak in neonates of Enterobacter cloa
cae infection resistant to third-generation cephalosporins. DESIGN: A
retrospective study of an outbreak in the neonatal intensive care unit
(NICU) and review of E cloacae isolates in pediatric wards and other
intensive care units from June 1992 through March 1993. SETTING: An ac
ademic tertiary care hospital. PATIENTS: Six patients admitted to the
NICU were colonized or infected with E cloacae resistant to third-gene
ration cephalosporins. In the period preceding the outbreak, four E cl
oacae isolates were available from four patients in the pediatric surg
ical ward. Nine isolates from four patients in two other intensive car
e units (ICUs) also were collected during the outbreak. Isolates were
biotyped by the API 50CH system and genotyped by polymerase chain reac
tion (PCR) fingerprinting. RESULTS: Typing by interrepeat PCR showed t
hat 21 isolates, which were obtained from five neonates, were identica
l. One neonate was colonized with a different strain. Some neonates we
re colonized with a single type of E cloacae for a relatively long per
iod of time. Isolates of patients who were cared for in the pediatric
surgical ward and the two other intensive care units (ICUs) showed dif
ferent genotypes. One patient in an ICU was colonized with an E cloaca
e strain genetically identical to the outbreak strain. No predominant
biotype could be established. CONCLUSIONS: E cloacae can colonize neon
ates for a long period of time and although colonization with E cloaca
e initially may arise endogenously, we were able to show further trans
mission by cross-contamination in a neonatal intensive care unit