ENTEROBACTER-CLOACAE IN A NEONATAL INTENSIVE-CARE UNIT - ACCOUNT OF AN OUTBREAK AND ITS RELATIONSHIP TO USE OF 3RD-GENERATION CEPHALOSPORINS

After uneventful use of cefotaxime and ceftazidime as first line thera py for three years in our neonatal intensive care unit we isolated cep halosporin-resistant Enterobacter cloacae (CREC) strains which caused clusters of cases or colonization and/or serious neonatal infection. B y using two or more typing methods, at least five different strains wi th similar patterns of antimicrobial sensitivities were identified. Th e results of a case-control study did not support the notion that the use of third generation cephalosporins was associated with colonizatio n and infection by CREC. The outbreak was brought under control by int errupting the transmission of the epidemic strain D, by measures such as cohort nursing, diligent handwashing before and after procedures, a nd through environmental cleaning as well as by decontamination with g lutaraldehyde after dismantling of the blood gas analyser believed to have acted as a persistent reservoir. Our experience highlights the da nger of inadequate supervision and maintenance of equipment used for n ear-patient testing and the need to monitor such equipment not only in terms of its calibration and analytical performance but also microbio logically.