[Clonal spreading of a multidrug resistance Citrobacter freundii strain at a neonatal intensive care unit]

This paper reports on the epidemic spreading of a multiresistant Citrobacter (C.) freundii strain at a neonatal intensive care unit. A premature baby of the 27th week of pregnancy died from septic shock caused by this strain. According to the result of a statistical analysis of risk factors a connection between the colonization of neonates and the feeding with an enteral feeding tube was probably. This suspicion could be confirmed by the detection of the multiresistant strain in the infant formula. Plasmid analysis, examination of outer membrane proteins and lipopolysaccharides of these C. freundii strains demonstrated the identity of all isolates. The resistance to antibiotics of this multiresistant C. freundii clone was determined by a plasmid belonging to incompatibility group C with a molecular weight of 110 MDa. This plasmid was involved also in other nosocomial outbreaks. It persisted more than 7 years in the hospital flora of the intensive care unit.