Department of Pediatrics, Bezmialem Vakif University, Adnan Menderes Bulvarı Vatan Caddesi 34093, Fatih, İstanbul, Turkey.
Braz J Infect Dis. 2013 Jul-Aug;17(4):450-4. doi: 10.1016/j.bjid.2013.01.008. Epub 2013 Jun 3.
We report an outbreak of Achromobacter xylosoxidans at a neonatal intensive care unit. We aimed to present clinical, laboratory and treatment data of the patients.
All consecutive episodes of bacteremia due to A. xylosoxidans at our neonatal intensive care unit, beginning with the index case detected at November 2009 until cessation of the outbreak in April 2010, were evaluated retrospectively.
Thirty-four episodes of bacteremia occurred in 22 neonates during a 6-month period. Among the affected, 90% were preterm newborns with gestational age of 32 weeks or less and 60% had birth weight of 1000g or less. Endotracheal intubation, intravenous catheter use, total parenteral nutrition and prolonged antibiotic therapy were the predisposing conditions. Presenting features were abdominal distention, thrombocytopenia and neutropenia. The mortality rate was 13.6% and the majority of isolates were susceptible to piperacillin-tazobactam, carbapenems and trimethoprim-sulfametoxazole, and resistant to gentamycin. More than half were breakthrough infections. Despite intensive efforts to control the outbreak by standard methods of hand hygiene, patient screening and isolation, containment could be achieved only after the neonatal intensive care unit was relocated. The investigation was not able to single out the source of the outbreak.
A. xylosoxidans has the potential to cause serious infections in premature babies. More studies are needed to determine the importance of different sources of infection in hospital units.
我们报告了新生儿重症监护病房中嗜木糖氧化无色杆菌的暴发情况。我们旨在呈现患者的临床、实验室和治疗数据。
从 2009 年 11 月检测到首例感染病例开始，到 2010 年 4 月暴发结束，我们回顾性评估了新生儿重症监护病房中所有连续发生的嗜木糖氧化无色杆菌菌血症病例。
在 6 个月期间，22 名早产儿中有 34 例发生菌血症。受影响的婴儿中，90%为早产儿，胎龄 32 周或以下，60%的出生体重为 1000g 或以下。气管内插管、静脉导管使用、全胃肠外营养和延长抗生素治疗是诱发条件。主要表现为腹胀、血小板减少和中性粒细胞减少。死亡率为 13.6%，大多数分离株对哌拉西林-他唑巴坦、碳青霉烯类和甲氧苄啶-磺胺甲恶唑敏感，对庆大霉素耐药。超过一半的感染为突破感染。尽管通过标准的手部卫生、患者筛查和隔离等方法来控制暴发，但只有在新生儿重症监护病房搬迁后才能实现控制。调查未能确定暴发的源头。
嗜木糖氧化无色杆菌有可能导致早产儿发生严重感染。需要进一步研究以确定医院病房中不同感染源的重要性。
