Increase of Enterobacter in neonatal sepsis: a twenty-two-year study

Background. Data on the incidence of Enterobacter infections in neonates ov er prolonged periods of time are scant. We determined the epidemiology of E nterobacter sepsis and/or meningitis and the trends of infection in a neona tal unit. Methods. Retrospective review of sepsis and/or meningitis in inborn neonate s admitted to Son Dureta University Hospital during a 22-year period. Molec ular study by ribotyping of the Enterobacter strains isolated from 1995 to 1997. Results. There were 513 cases of culture-proved sepsis and/or meningitis in neonates, In late onset infections Klebsiella pneumoniae and Staphylococcu s epidermidis were the most frequent isolates in the period 1977 through 19 91, Enterobacter was the most common isolate in the period 1992 through 199 8. During this latter period Candida infections also increased, and the res istance rate of Enterobacter to cefotaxime was higher (59,2%). Decrease in early onset infections and increase in late onsets (4.6/1000 live births) w ere observed in the second period, From 1977 to 1998, 45 episodes of sepsis and/or meningitis by Enterobacter species were identified in 44 patients ( 8.7% of all neonatal bacteremias), Three patients with Enterobacter bactere mia died (6.6%, 0.03/1000 live births). During 1995 through 1997 5 differen t clones causing sepsis were identified and 3 were predominant. In 1997 the re was an outbreak of Enterobacter disease. After cleaning, cohort nursing and hygiene reinforcement, Enterobacter was not isolated in the next 2 year s. No change in the antibiotic policy was made. Conclusions. We observed a resurgence of Enterobacter infections in our neo natal intensive care unit, The sudden disappearance of this microorganism a fter reinforcement of hygienic measures, without withdrawing cefotaxime, co nfirms the importance of patient-to-patient transmission of this nosocomial infection. Further studies are needed to establish the role of antibiotics in the emergence of microorganisms in neonatal intensive care units.