Related Experiment Videos
Epidemic nosocomial meningitis due to Citrobacter diversus in neonates
Abstract:
Five infants born at one hospital over a two-year period developed meningitis due to a serotype O2 strain of Citrobacter diversus; four infants developed brain abscesses due to this organism. The initial prevalence of stool colonization in infants was 79%; eventually 140 infants (10%) and six nurses (6%) were found to be colonized. One colonized infant remained in the hospital for the entire two-year period. The strains were of two biotypes marked by the presence (biotype d) or absence (biotype a) of fermentation of sucrose and dulcitol. The biotype d strain was found in the five infants with meningitis, 110 asymptomatic infants, and five nurses. The biotype a strain, which was isolated from 30 infants and one nurse, did not cause disease. Colonized infants were distinguished by intensive care therapy (P = 10-31), gavage feeding (P = 0.036), and prenatal intrauterine monitoring (P = 0.037). These findings suggest a fecal reservoir and person-to-person transmission of C. diversus. Measures to control the outbreak cost about $110,000.
Insights
A Citrobacter diversus outbreak caused meningitis and brain abscesses in five infants. The study identified a fecal reservoir and person-to-person transmission, highlighting risks in neonatal intensive care units.
Area of Science:
- Infectious Diseases
- Neonatal Care
- Microbiology
Background:
- Citrobacter diversus serotype O2 strains can cause serious infections in infants.
- Neonatal intensive care units (NICUs) are susceptible to bacterial outbreaks.
- Understanding transmission dynamics is crucial for infection control.
Purpose of the Study:
- To investigate an outbreak of meningitis and brain abscesses caused by Citrobacter diversus in infants.
- To identify the source, transmission routes, and risk factors associated with the outbreak.
- To characterize the strains of Citrobacter diversus involved.
Main Methods:
- Retrospective case-control study analyzing infant and healthcare worker colonization.
- Biotyping of Citrobacter diversus strains based on sucrose and dulcitol fermentation.
- Statistical analysis to identify risk factors for colonization.
Main Results:
- Five infants developed meningitis and four developed brain abscesses due to Citrobacter diversus.
- High initial infant stool colonization (79%), with 140 infants and six nurses colonized overall.
- Biotype d strain linked to invasive disease; biotype a caused asymptomatic colonization.
- Risk factors for colonization included intensive care, gavage feeding, and prenatal monitoring.
Conclusions:
- Citrobacter diversus serotype O2 poses a significant threat to neonates.
- Fecal reservoir and person-to-person transmission are likely routes for C. diversus spread.
- Enhanced infection control measures are necessary in NICUs to prevent such outbreaks.