Hospices Civils de Lyon, Service de Néonatologie et Réanimation Néonatale, Hôpital Femme Mère 59 Boulevard Pinel, 69500, Bron, France.
Hospices Civils de Lyon, Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Groupement Hospitalier Nord, Lyon, France.
BMC Infect Dis. 2020 Sep 17;20(1):682. doi: 10.1186/s12879-020-05406-8.
Enterobacter cloacae species is responsible for nosocomial outbreaks in vulnerable patients in neonatal intensive care units (NICU). The environment can constitute the reservoir and source of infection in NICUs. Herein we report the impact of preventive measures implemented after an Enterobacter cloacae outbreak inside a NICU.
This retrospective study was conducted in one level 3 NICU in Lyon, France, over a 6 year-period (2012-2018). After an outbreak of Enterobacter cloacae infections in hospitalized neonates in 2013, several measures were implemented including intensive biocleaning and education of medical staff. Clinical and microbiological characteristics of infected patients and evolution of colonization/infection with Enterobacter spp. in this NICU were retrieved. Moreover, whole genome sequencing was performed on 6 outbreak strains.
Enterobacter spp. was isolated in 469 patients and 30 patients developed an infection including 2 meningitis and 12 fatal cases. Preventive measures and education of medical staff were not associated with a significant decrease in patient colonisation but led to a persistent decreased use of cephalosporin in the NICU. Infection strains were genetically diverse, supporting the hypothesis of multiple hygiene defects rather than the diffusion of a single clone.
Grouped cases of infections inside one setting are not necessarily related to a single-clone outbreak and could reveal other environmental and organisational problematics. The fight against implementation and transmission of Enterobacter spp. in NICUs remains a major challenge.
阴沟肠杆菌是导致新生儿重症监护病房（NICU）中脆弱患者发生医院感染的原因。环境可能是 NICU 感染的储层和来源。在此，我们报告了在 NICU 中发生阴沟肠杆菌爆发后实施预防措施的影响。
本回顾性研究在法国里昂的一家 3 级 NICU 进行，时间跨度为 6 年（2012-2018 年）。2013 年，住院新生儿发生阴沟肠杆菌感染爆发后，采取了多项措施，包括强化生物清洁和医务人员教育。检索了感染患者的临床和微生物学特征以及该 NICU 中阴沟肠杆菌定植/感染的演变情况。此外，对 6 株暴发菌株进行了全基因组测序。
共分离出 469 例患者的阴沟肠杆菌，其中 30 例患者发生感染，包括 2 例脑膜炎和 12 例死亡。预防措施和医务人员教育与患者定植率的显著降低无关，但导致 NICU 中头孢菌素的使用持续减少。感染株具有遗传多样性，支持存在多个卫生缺陷而非单一克隆扩散的假设。
同一环境中聚集的感染病例不一定与单一克隆爆发有关，可能揭示了其他环境和组织问题。防治阴沟肠杆菌在 NICU 中的传播仍然是一个重大挑战。
