Dalben M, Varkulja G, Basso M, Krebs V L J, Gibelli M A, van der Heijden I, Rossi F, Duboc G, Levin A S, Costa S F
Hospital das Clínicas, University of São Paulo, Department of Infectious Diseases, São Paulo, Brazil.
J Hosp Infect. 2008 Sep;70(1):7-14. doi: 10.1016/j.jhin.2008.05.003. Epub 2008 Jul 16.
Enterobacter cloacae has emerged as an important pathogen in neonatal units, with several outbreaks of infection being reported. The aim of this study was to investigate an outbreak of sepsis due to E. cloacae in a neonatal unit and to review the literature. A retrospective cohort study was conducted in which cases were compared with all newborns hospitalised for more than 48h in the neonatal intensive care unit (NICU). Cohorting of infected patients and work reorganisation were implemented. Pulsed-field gel electrophoresis was performed. The retrospective cohort included the six cases and 13 control patients that had been in the NICU during April 2006. Univariate analysis showed that the use of dobutamine was significantly associated with infection (P=0.036) and that enteral feeding was a protective factor (P=0.02). Multivariate analysis did not find any independent risk factor. Bed occupancy rate in March 2006 was 109.6%, indicating overcrowding. PFGE identified indistinguishable patterns among isolates from all six newborns. PubMed and OVID was search from 1 January 1983 to 15 January 2008 for papers including the terms 'E. cloacae', 'outbreaks', 'clusters' in combination with 'neonate', 'newborn', and 'infant'. We found 26 reports of outbreaks due to E. cloacae in neonate patients: sixteen (52%) were bloodstream infection outbreaks, of which two (12.5%) were related to multiple-dose medications. The source for our outbreak was not identified. Reinforcement of hygiene practices, restrictions on new admissions and the establishment of single-dose medications helped to control the outbreak.
阴沟肠杆菌已成为新生儿病房中的一种重要病原体，已有多起感染暴发的报道。本研究的目的是调查一家新生儿病房中由阴沟肠杆菌引起的败血症暴发情况，并对相关文献进行综述。开展了一项回顾性队列研究，将病例与新生儿重症监护病房（NICU）中住院超过48小时的所有新生儿进行比较。对感染患者进行了队列研究并实施了工作重组。进行了脉冲场凝胶电泳。回顾性队列包括2006年4月期间在NICU的6例病例和13例对照患者。单因素分析显示，使用多巴酚丁胺与感染显著相关（P = 0.036），而肠内喂养是一个保护因素（P = 0.02）。多因素分析未发现任何独立危险因素。2006年3月的床位占用率为109.6%，表明存在过度拥挤情况。脉冲场凝胶电泳确定所有6例新生儿分离株的图谱无法区分。在PubMed和OVID上检索了1983年1月1日至2008年1月15日期间包含“阴沟肠杆菌”、“暴发”、“聚集”与“新生儿”、“新生儿”和“婴儿”组合的术语的论文。我们发现了26篇关于新生儿患者阴沟肠杆菌暴发的报告：16篇（52%）为血流感染暴发，其中2篇（12.5%）与多剂量药物有关。本次暴发的源头未查明。加强卫生措施、限制新入院患者以及建立单剂量药物有助于控制暴发。
