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Nosocomial spread of Haemophilus influenzae type b infection documented by outer membrane protein subtype analysis
Abstract:
This report provides evidence of nosocomial transmission of Haemophilus influenzae type b infection between two children in an acute care hospital. In the past, transmission of infection between these children would have gone unrecognized, because the isolates from the respective cases differed in susceptibility to ampicillin. However, the outer membrane protein profile of the two isolates was identical and has previously been observed in less than 2% of type b Haemophilus isolates from patients with invasive disease in the St. Louis area. Thus the likelihood is very low that these two children were both infected with this strain by chance alone (P less than 0.0004). From previous experience, the risk of transmission of Haemophilus in an acute care setting would appear to be very low. However, nosocomial transmission may occasionally occur.
Insights
Nosocomial transmission of Haemophilus influenzae type b occurred between two children in a hospital. Identical outer membrane protein profiles suggest a shared source, despite differing ampicillin resistance.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Epidemiology
- Microbiology
Background:
- Haemophilus influenzae type b (Hib) is a significant cause of invasive bacterial disease in children.
- Understanding transmission dynamics is crucial for infection control in healthcare settings.
- Previous studies suggested a low risk of Hib transmission in acute care.
Observation:
- Two pediatric cases of invasive Hib infection were identified in an acute care hospital.
- Isolates showed differing ampicillin susceptibility, initially masking potential transmission.
- Identical outer membrane protein profiles were observed in both isolates.
Findings:
- The identical outer membrane protein profiles, rare in invasive Hib strains (<2%), strongly indicate nosocomial transmission.
- The probability of unrelated infections by this specific strain is extremely low (P < 0.0004).
- This case highlights that nosocomial transmission of Hib can occur, challenging previous assumptions of low risk.
Implications:
- Healthcare facilities must maintain vigilance for nosocomial infections, even those presumed rare.
- Advanced molecular typing (outer membrane protein profiling) is vital for confirming transmission events.
- Infection control strategies should consider the potential for rare but significant transmission of pathogens like Hib.