Enterobacter cloacae sepsis outbreak in a newborn unit caused by contaminated total parenteral nutrition solution

Objective: The study aimed to investigate an outbreak caused by Enterobacte r cloacae in a neonate intensive care unit. Design: A descriptive study of an outbreak of sepsis in high-risk neonates was used. Setting: The study was set in a tertiary care university teaching hospital. Patients: The patients were 11 neonates infected with Enterobacter cloacae whose symptoms and signs of sepsis developed during a 16-hour period. All b ut one neonate received parenteral nutrition. Isolates from blood cultures, in-use parenteral nutrition solutions, and control aliquots of parenteral nutrition solution were typed by pulsed-field gel electrophoresis. Results: Enterobacter cloacae was found in the refrigerated aliquots of par enteral nutrition solution, in blood cultures from infected newborns, and f rom in-use parenteral nutrition solutions. All these strains of Enterobacte r cloacae had the same antibiotic susceptibility pattern and the same genom ic DNA profile. The strain isolated from the one patient who did not receiv e parenteral nutrition presented a different susceptibility profile and gen otype. Conclusion: The source of the nosocomial sepsis was the parenteral nutritio n solution in 10 neonates. This contamination apparently occurred during pr eparation of the parenteral solution.