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Streptococcus faecium outbreak in a neonatal intensive care unit
Insights
A hospital outbreak of bacteremia and meningitis in premature infants was linked to Streptococcus faecium. Rapid identification systems helped distinguish epidemic strains from environmental ones, highlighting the need for species-level identification.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Microbiology
Background:
- Nosocomial outbreaks of bacteremia and meningitis pose significant risks to vulnerable premature infants in neonatal intensive care units.
- Streptococcus faecium has emerged as a potential pathogen in neonatal infections, necessitating effective identification and control strategies.
Purpose of the Study:
- To describe a nosocomial outbreak of bacteremia and meningitis caused by Streptococcus faecium in a neonatal intensive care unit.
- To investigate the transmission dynamics and identify the causative strain using advanced microbiological techniques.
Main Methods:
- Epidemiological investigation of seven cases in premature infants with severe underlying conditions.
- Comparative analysis of bacterial isolates using conventional biotyping and rapid identification systems (API-20S, AutoMicrobic system).
- Environmental and personnel screening for Streptococcus faecium.
Main Results:
- Conventional biotyping could not differentiate epidemic strains from environmental isolates.
- Rapid identification systems successfully distinguished Streptococcus faecium isolates from infected patients and hospital personnel from those found in general surveys and the environment.
- Transmission was suspected to occur via the hands of hospital personnel.
Conclusions:
- This is the first reported nosocomial neonatal outbreak of bacteremia and meningitis due to Streptococcus faecium.
- Accurate, species-level identification of streptococci is crucial for controlling nosocomial infections.
- Emphasis on hand hygiene among healthcare personnel is critical in preventing transmission.
Abstract:
An outbreak of bacteremia and meningitis in a neonatal intensive care unit is described. Seven cases occurred in premature infants with severe underlying diseases. An epidemiological investigation failed to document the reservoir of the epidemic strain but suggested that its transmission among the infants was via the hands of hospital personnel. All patients had nasogastric tubes and multiple intravascular devices, and the portal of entry may have been either the gastrointestinal tract or the sites of the intravascular devices. Conventional biotyping of isolates failed to differentiate between isolates from infected patients and isolates recovered from prevalence surveys and from the environment. However, rapid identification systems (API-20S [Analytab Products, Plainview, N.Y.] and the AutoMicrobic system [Vitek Systems, Inc., Hazelwood, Mo.]) were able to distinguish isolates recovered from infected patients and hands of hospital personnel from isolates recovered during prevalence and environmental surveys and 29 isolates from widespread geographical areas. This is the first known report of a nosocomial neonatal outbreak of bacteremia and meningitis due to Streptococcus faecium; it underscores the importance of identifying streptococci to species level.