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Published on: February 17, 2023
Molecular epidemiology of Enterobacter cloacae in a neonatal department: a 2-year surveillance study
H Gbaguidi-Haore1, D Talon, M Thouverez
1Service d'Hygiène Hospitalière et d'Epidémiologie moléculaire, Centre Hospitalier Universitaire Besançon, Besançon cedex, France.
Insights
Enterobacter cloacae intestinal colonization is common in neonates, primarily spreading between patients, not from mothers. Strict infection control is crucial for preventing transmission in neonatal units.
Area of Science:
- Neonatal infectious diseases
- Molecular epidemiology
- Bacterial genetics
Background:
- Enterobacter cloacae is a significant nosocomial pathogen in neonatal intensive care units.
- Neonatal units are vulnerable to the spread of multidrug-resistant organisms.
- Understanding transmission dynamics is key to effective infection control.
Purpose of the Study:
- To investigate the molecular epidemiology of Enterobacter cloacae in neonatal units.
- To determine the primary routes of E. cloacae transmission in neonates.
- To assess the contribution of mother-to-child transmission versus patient-to-patient spread.
Main Methods:
- A 2-year surveillance program involving screening of neonates and mothers for E. cloacae intestinal colonization.
- Pulsed-field gel electrophoresis (PFGE) for genotyping bacterial isolates.
- Analysis of genetic relatedness to identify transmission pathways.
Main Results:
- 22.6% of neonates (166/735) exhibited E. cloacae intestinal colonization.
- 3.9% of neonates (29/735) had clinical samples positive for E. cloacae.
- PFGE identified 90 pulsotypes, including three major epidemic clones, with patient-to-patient transmission dominating over mother-to-child transmission (8.8% of cases).
Conclusions:
- Patient-to-patient transmission is the predominant route for Enterobacter cloacae spread in neonatal units.
- Mother-to-child transmission plays a minor role in neonatal E. cloacae colonization.
- Adherence to infection control protocols by healthcare workers is critical for preventing outbreaks.
Abstract:
A surveillance program was implemented to investigate the molecular epidemiology of Enterobacter cloacae in neonatal units. This program ran for 2 years and involved screening for E. cloacae intestinal colonization of all infants at admission and weekly thereafter. In addition, mothers whose children were admitted to neonatal units were also screened. Pulsed-field gel electrophoresis analysis was used to establish genetic relationships between strains and to identify mother-to-child transmission. During the survey period, 166 (22.6%) of the 735 included children had E. cloacae intestinal colonization, and 29 (3.9%) patients gave clinical samples positive for E. cloacae. Genotyping revealed 90 different pulsotypes in the 199 clinical and screening isolates from neonates, including three major epidemic clones. Mother-to-child transmission of E. cloacae was directly responsible for 8.8% of intestinal colonization of the neonates. This surveillance program reveals a major contribution of patient-to-patient transmission and the rarity of mother-to-child transmission in the spread of E. cloacae in neonates. This highlights the importance of good compliance with infection control procedures by health-care workers.
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