Hervas J A, Ballesteros F, Alomar A, Gil J, Benedi V J, Alberti S
Department of Neonatology, Unidad de Investigación, Hospital Universitario Son Dureta, Spain.
Pediatr Infect Dis J. 2001 Feb;20(2):134-40. doi: 10.1097/00006454-200102000-00003.
Data on the incidence of Enterobacter infections in neonates over prolonged periods of time are scant. We determined the epidemiology of Enterobacter sepsis and/or meningitis and the trends of infection in a neonatal unit.
Retrospective review of sepsis and/or meningitis in inborn neonates admitted to Son Dureta University Hospital during a 22-year period. Molecular study by ribotyping of the Enterobacter strains isolated from 1995 to 1997.
There were 513 cases of culture-proved sepsis and/or meningitis in neonates. In late onset infections Klebsiella pneumoniae and Staphylococcus epidermidis were the most frequent isolates in the period 1977 through 1991. Enterobacter was the most common isolate in the period 1992 through 1998. During this latter period Candida infections also increased, and the resistance rate of Enterobacter to cefotaxime was higher (59.2%). Decrease in early onset infections and increase in late onsets (4.6/1,000 live births) were 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 bacteremia died (6.6%, 0.03/1,000 live births). During 1995 through 1997 5 different clones causing sepsis were identified and 3 were predominant. In 1997 there was an outbreak of Enterobacter disease. After cleaning, cohort nursing and hygiene reinforcement, Enterobacter was not isolated in the next 2 years. No change in the antibiotic policy was made.
We observed a resurgence of Enterobacter infections in our neonatal intensive care unit. The sudden disappearance of this microorganism after reinforcement of hygienic measures, without withdrawing cefotaxime, confirms 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.
长期以来，关于新生儿肠杆菌感染发病率的数据很少。我们确定了新生儿病房中肠杆菌败血症和/或脑膜炎的流行病学情况以及感染趋势。
对Son Dureta大学医院在22年期间收治的足月新生儿败血症和/或脑膜炎进行回顾性研究。对1995年至1997年分离出的肠杆菌菌株进行核糖体分型分子研究。
新生儿中有513例经培养证实的败血症和/或脑膜炎病例。在晚发性感染中，1977年至1991年期间最常见的分离菌是肺炎克雷伯菌和表皮葡萄球菌。1992年至1998年期间，肠杆菌是最常见的分离菌。在后一时期，念珠菌感染也有所增加，肠杆菌对头孢噻肟的耐药率更高（59.2%）。在第二个时期，观察到早发性感染减少，晚发性感染增加（4.6/1000活产）。1977年至1998年，44例患者中发现45例由肠杆菌属引起的败血症和/或脑膜炎（占所有新生儿菌血症的8.7%）。3例肠杆菌菌血症患者死亡（6.6%，0.03/1000活产）。1995年至1997年期间，鉴定出5种不同的引起败血症的克隆，其中3种占主导地位。1997年发生了一次肠杆菌疾病暴发。经过清洁、分组护理和加强卫生措施后，在接下来的2年中未分离出肠杆菌。抗生素政策未作改变。
我们观察到新生儿重症监护病房中肠杆菌感染有所复发。在加强卫生措施后，这种微生物突然消失，而未停用头孢噻肟，这证实了这种医院感染在患者之间传播的重要性。需要进一步研究以确定抗生素在新生儿重症监护病房微生物出现过程中的作用。
