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Published on: February 9, 2011
[Nosocomial colonization and infection by multiresistant Enterobacter cloacae strains on a pediatric oncological
E Ritter1, V Thurm, A Bauernfeind
1Institut für Hygiene und Laboratoriumsmedizin, Städtischen Krankenanstalten Krefeld.
Insights
A multiresistant Enterobacter cloacae strain spread in a pediatric oncology ward, causing infections in nine children. Strict infection control measures significantly reduced further spread and infections.
Area of Science:
- Infectious Diseases
- Microbiology
- Hospital Epidemiology
Background:
- A multiresistant Enterobacter cloacae strain caused an outbreak in a pediatric oncology ward over six months.
- Nine children with various tumors and malformations were affected, with three sharing a room being particularly impacted.
- Enterobacter cloacae was isolated frequently from patients and their environment, including blood, catheters, and skin.
Purpose of the Study:
- To investigate the spread and characteristics of a multiresistant Enterobacter cloacae strain in a pediatric oncology ward.
- To compare the antimicrobial resistance patterns of the outbreak strain with isolates from other hospital wards.
- To evaluate the effectiveness of infection control interventions in reducing the incidence of infections.
Main Methods:
- Epidemiological surveillance and bacterial isolation from patients and environmental samples.
- Antimicrobial susceptibility testing, including resistance to beta-lactam antibiotics, aminoglycosides, and quinolones.
- Molecular typing methods such as RFLP and analysis of enzyme and whole cell profiles to compare isolates.
Main Results:
- The majority of Enterobacter cloacae strains were resistant to multiple antibiotics but sensitive to imipenem, aminoglycosides, and quinolones.
- Isolates from the pediatric oncology ward showed identical antimicrobial resistance patterns, bacteriocin types, RFLP types, and enzyme/whole cell profiles, indicating a single clone.
- Isolates from other hospital wards exhibited significantly different patterns.
- Systematic patient management and infection control measures led to a significant reduction in infections.
Conclusions:
- A specific clone of multiresistant Enterobacter cloacae caused a prolonged outbreak in a vulnerable pediatric oncology population.
- The outbreak strain exhibited a distinct resistance profile compared to isolates from other hospital areas.
- Effective infection control strategies, including patient isolation and registration, are crucial for managing and preventing the spread of multiresistant bacteria in healthcare settings.
Abstract:
A multiresistant E. cloacae strain spread during a six month period in a paediatric oncology ward amongst nine children, who had different tumors and malformations. Three children who had shared a room were especially affected. E. cloacae was isolated 122 times from the children with tumors and five times from their environment. Specimens from which the bacteria were isolated, included blood cultures, catheter tips, wound swabs, drains, skin and mucous membranes from most parts of the body. The majority of the E. cloacae strains were resistant to ampicillin, mezlocillin, piperacillin, azlocillin, doxycycline and cephalosporins of the second and third generation and sensitive to imipenem, aminoglycosides and quinolones. The antimicrobial resistance patterns of the E. cloacae strains from the paediatric oncology ward were compared to those isolated from other wards in the hospital. E. cloacae isolates from the intensive care unit had a reduced sensitivity to beta-lactam antibiotics, whereas the isolates from the other wards were, with the exception of ampicillin, sensitive to beta-lactam antibiotics. The analysis of the E. cloacae strains from the paediatric oncology ward revealed the same antimicrobial resistance pattern, bacteriocin type, RFLP-type and an identical enzyme and whole cell profile. Isolates from other wards showed considerably deviating patterns. The systematic registration and isolation of patients, colonized or infected with multiresistant E. cloacae strains, together with infection control methods, lead to a significant reduction in infections.
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