Guo Qiaozhi, Zhao Xiaopeng, Ma Jingxiang, Zhou Yi, Gao Fei, Huang Wei, Sun Li, Zhu Sufei, Li Lijuan, Sun Huimin, Jia Wei, Zhang Huayan, Zhao Danyang
Hospital Infection Control Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China.
Division of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China.
Indian J Med Microbiol. 2024 Nov-Dec;52:100741. doi: 10.1016/j.ijmmb.2024.100741. Epub 2024 Oct 15.
This article describes the origin of a S. marcescens outbreak in a neonatal intensive care unit (NICU).
A retrospective case-control study including 12 S. marcescens-positive and 22 S. marcescens-negative neonates in the NICU was performed to identify the source of the outbreak. S. marcescens isolates were collected during the outbreak and analyzed using whole-genome sequencing (WGS). IQ-Tree software, BEAST2 software package and SCOTTI software were used to construct a phylogenetic tree and a propagation path map.
The index case occurred on February 21st and outbreak ended on March 9th, 2021, affecting a total of 12 neonates (2 with S. marcescens infection and 10 with S. marcescens colonization). Multivariate logistic regression identified that the distance of <0.8 m between the bed unit and the sink (odds ratio [OR], 20.50; 95 % confidence interval [CI], 1.09-384.86), a large number of rotating nurses within a week (OR 2.58, 95 % CI, 1.09-6.11) and use of humidification water in the incubator (OR 189.70, 95 % CI, 2.76-13027.31) were significant increased risk factors for S. marcescens infection or colonization in the outbreak. WGS sifted out a predominant clone between contaminated handwashing sinks and patients, suggesting that cross-transmission was involved in the dissemination of S. marcescens.
Contaminated handwashing sinks can be a communication intermediary of S. marcescens infection or colonization of neonates in the NICU. A distance of <0.8 m between the bed unit and the sink, and a large number of rotating nurses might play important roles in this outbreak. Attention should be paid to sinks contamination and contact transmission to prevent outbreaks.
本文描述了新生儿重症监护病房（NICU）中粘质沙雷氏菌暴发的起源。
进行了一项回顾性病例对照研究，纳入了NICU中12例粘质沙雷氏菌阳性和22例粘质沙雷氏菌阴性的新生儿，以确定暴发源。在暴发期间收集粘质沙雷氏菌分离株，并使用全基因组测序（WGS）进行分析。使用IQ-Tree软件、BEAST2软件包和SCOTTI软件构建系统发育树和传播路径图。
首例病例发生于2021年2月21日，暴发于2021年3月9日结束，共影响12例新生儿（2例粘质沙雷氏菌感染和10例粘质沙雷氏菌定植）。多因素logistic回归分析确定，病床单元与水槽之间距离<0.8 m（比值比[OR]，20.50；95%置信区间[CI]，1.09 - 384.86）、一周内大量轮转护士（OR 2.58，95% CI，1.09 - 6.11）以及在培养箱中使用湿化水（OR 189.70，95% CI，2.76 - 13027.31）是此次暴发中粘质沙雷氏菌感染或定植的显著增加的危险因素。WGS筛选出污染的洗手池与患者之间的一个主要克隆，提示交叉传播参与了粘质沙雷氏菌的传播。
污染的洗手池可能是NICU中新生儿粘质沙雷氏菌感染或定植的传播媒介。病床单元与水槽之间距离<0.8 m以及大量轮转护士可能在此次暴发中起重要作用。应注意水槽污染和接触传播以预防暴发。
