K Nakamura1, M Kaneko2, Y Abe3, N Yamamoto4, H Mori5, A Yoshida5, K Ohashi6, S Miura7, T T Yang7, N Momoi2, K Kanemitsu4. 1. Department of Infection Control, Fukushima Medical University, Fukushima, Japan; Infection Control Unit, Fukushima Medical University Hospital, Fukushima, Japan. Electronic address: kinakamu@fmu.ac.jp. 2. Department of Pediatrics, Fukushima Medical University, Fukushima, Japan. 3. Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan. 4. Department of Infection Control, Fukushima Medical University, Fukushima, Japan; Infection Control Unit, Fukushima Medical University Hospital, Fukushima, Japan. 5. Infection Control Unit, Fukushima Medical University Hospital, Fukushima, Japan. 6. Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, Fukushima, Japan. 7. Department of Infection Control, Fukushima Medical University, Fukushima, Japan.
Abstract
BACKGROUND: Routine surveillance in a neonatal intensive care unit (NICU) showed an increased detection of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-E. coli) in August 2012, following nearly a year without detection. AIM: To describe the investigation and interventions by a hospital infection control team of an outbreak of ESBL-E. coli in a NICU. METHODS: Six neonates with positive cultures of ESBL-E. coli (five with respiratory colonization, one with a urinary tract infection), control infants who were negative for ESBL-E. coli during the study period, and mothers who donated their breast milk were included. A case-control study was performed to identify possible risk factors for positive ESBL-E. coli cultures and molecular typing of isolated strains by pulsed-field gel electrophoresis. FINDINGS: The odds ratio for ESBL-E. coli infection after receiving shared unpasteurized breast milk during the study period was 49.17 (95% confidence interval: 6.02-354.68; P < 0.05). The pulsed-field gel electrophoresis pattern showed that all strains were identical, and the same pathogen was detected in freshly expressed milk of a particular donor. After ceasing the breast milk sharing, the outbreak was successfully terminated. CONCLUSION: This outbreak indicates that contamination of milk packs can result in transmission of a drug-resistant pathogen to newborn infants. Providers of human breast milk need to be aware of the necessity for low-temperature pasteurization and bacterial cultures, which should be conducted before and after freezing, before prescribing to infants.
BACKGROUND: Routine surveillance in a neonatal intensive care unit (NICU) showed an increased detection of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-E. coli) in August 2012, following nearly a year without detection. AIM: To describe the investigation and interventions by a hospital infection control team of an outbreak of ESBL-E. coli in a NICU. METHODS: Six neonates with positive cultures of ESBL-E. coli (five with respiratory colonization, one with a urinary tract infection), control infants who were negative for ESBL-E. coli during the study period, and mothers who donated their breast milk were included. A case-control study was performed to identify possible risk factors for positive ESBL-E. coli cultures and molecular typing of isolated strains by pulsed-field gel electrophoresis. FINDINGS: The odds ratio for ESBL-E. coli infection after receiving shared unpasteurized breast milk during the study period was 49.17 (95% confidence interval: 6.02-354.68; P < 0.05). The pulsed-field gel electrophoresis pattern showed that all strains were identical, and the same pathogen was detected in freshly expressed milk of a particular donor. After ceasing the breast milk sharing, the outbreak was successfully terminated. CONCLUSION: This outbreak indicates that contamination of milk packs can result in transmission of a drug-resistant pathogen to newborn infants. Providers of human breast milk need to be aware of the necessity for low-temperature pasteurization and bacterial cultures, which should be conducted before and after freezing, before prescribing to infants.
Authors: M Zamfir; A C Adler; S Kolb; A Dammeyer; L Nasri; L Schomacher; B Karlin; M Franitza; S Hörmansdorfer; C Tuschak; G Valenza; U Ochmann; C Herr Journal: Eur J Clin Microbiol Infect Dis Date: 2017-05-04 Impact factor: 3.267
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Authors: Diana Escuder-Vieco; Irene Espinosa-Martos; Juan M Rodríguez; Nieves Corzo; Antonia Montilla; Pablo Siegfried; Carmen R Pallás-Alonso; Leónides Fernández Journal: Front Microbiol Date: 2018-05-11 Impact factor: 5.640