Qutaishat Salah S, Stemper Mary E, Spencer Susan K, Borchardt Mark A, Opitz James C, Monson Timothy A, Anderson Jennifer L, Ellingson Jay L E
Saint Joseph's Hospital, Marshfield, WI 54449, USA.
Pediatrics. 2003 Jun;111(6 Pt 1):1442-6. doi: 10.1542/peds.111.6.1442.
This study documents the first reported transmission of Salmonella enterica serotype Typhimurium definitive type 104 (DT104) to premature fraternal twins via their mother's breast milk. When premature twin neonates developed severe enteritis in the neonatal intensive care unit (NICU), stool samples and the mother's breast milk were cultured for the presence of Salmonella. Antibacterial susceptibility patterns were determined. Semiquantitative organism abundance data were retrospectively gathered on 54 stored breast milk samples collected on 34 different days using a rapid, real-time polymerase chain reaction (PCR) methodology (LightCycler PCR). Fecal samples from other infants in the NICU at that time were also tested. Pulsed-field gel electrophoresis (PFGE) was used to assess the genetic composition of the isolated organisms. The twins' neonatal stools and mother's breast milk cultures revealed a resistance pattern (R-type) to ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline. LightCycler PCR analysis of sequential breast milk samples confirmed this to be the likely source of transmission. In the subsequent outbreak investigation, none of the NICU surveillance fecal samples proved positive for this organism. The genetic composition of organisms isolated from the maternal breast milk was indistinguishable from those isolated from neonatal specimens as determined by PFGE. Antibiotic susceptibility tests coupled with PFGE patterns suggested that these Salmonella isolates were DT104. Because the prevalence of DT104 infections is rising in the United States, neonatologists should be aware of breast milk as a potential mode of transmission.
本研究记录了首例有报告的肠炎沙门氏菌鼠伤寒血清型104型（DT104）通过母亲的母乳传播给早产异卵双胞胎的病例。早产双胎新生儿在新生儿重症监护病房（NICU）发生严重肠炎时，对粪便样本和母亲的母乳进行沙门氏菌培养，并确定抗菌药敏模式。使用快速实时聚合酶链反应（PCR）方法（LightCycler PCR），回顾性收集了在34个不同日期采集的54份储存母乳样本中的半定量微生物丰度数据。当时NICU中其他婴儿的粪便样本也进行了检测。脉冲场凝胶电泳（PFGE）用于评估分离出的微生物的基因组成。双胞胎的新生儿粪便和母亲的母乳培养显示对氨苄西林、氯霉素、链霉素、磺胺类药物和四环素具有耐药模式（R型）。对连续母乳样本的LightCycler PCR分析证实这可能是传播源。在随后的疫情调查中，NICU监测的粪便样本均未检测出该微生物呈阳性。通过PFGE测定，从母乳中分离出的微生物的基因组成与从新生儿标本中分离出的微生物无法区分。抗生素药敏试验和PFGE模式表明，这些沙门氏菌分离株为DT104。由于DT104感染在美国的患病率正在上升，新生儿科医生应意识到母乳是一种潜在的传播途径。
