O. Finnstrom et al., CONTROL OF AN OUTBREAK OF A HIGHLY BETA-LACTAM-RESISTANT ENTEROBACTER-CLOACAE STRAIN IN A NEONATAL SPECIAL CARE UNIT, Acta paediatrica, 87(10), 1998, pp. 1070-1074
Two successive outbreaks of colonization and infection with Enterobact
er cloacae resistant to third generation cephalosporins (cephalosporin
-resistant E. cloacae, CREC) and involving 15 infants occurred within
12 months in a neonatal special care unit. Isolates of clinical signif
icance were obtained from four infants (urine 2 cases, blood, pleural
drainage). According to epidemiological typing using computerized bioc
hemical fingerprinting and pulsed-field gel electrophoresis (PFGE) the
same CREC strain was found in both outbreaks. The origin of the strai
n and its reservoir between the two outbreaks remained unknown. Emphas
izing strict barrier nursing of the infants had little or no impact on
the presence and transmission of the strain in the unit. In contrast,
replacing ampicillin plus cefotaxime as standard empiric therapy with
penicillin G plus netilmicin plus consequent cohorting of newborns an
d staff promptly halted both the outbreaks. During a 5-y follow-up aft
er the last episode, the choice of antibiotics for empirical treatment
has varied, and no further outbreaks of CREC have been seen, with the
exception of two sporadic cases.