Enteroaggregative Escherichia coli associated with an outbreak of diarrhoea in a neonatal nursery ward.

Over a 9-day period in February 1995, 16 newborn babies (age range 2-11 days) and 3 infants (24, 47 and 180 days of age) in a neonatal nursery ward developed diarrhoea accompanied by pyrexia and weight loss. Known enteropathogens were not detected in their stools but Escherichia coli displaying aggregative adherence to HEp-2 cells (enteroaggregative E. coli) were found in 12 (63%) ill infants and in none of 5 well neonates (P = 0.02). The illness lasted 3-9 days (mean 5.2) in 16 babies, whereas in 3 neonates it showed a protracted course of 18-20 days. The source of infection and the mode of transmission remained unclear. The outbreak isolates manifested properties common in this new group of diarrhoeagenic E. coli: mannose-resistant haemagglutination, haemolysis on blood agar, and clump formation in liquid culture medium. They belonged to the O4 E. coli serogroup and expressed multiple antibiotic resistance.