Pseudomonas aeruginosa infections in a neonatal intensive care unit

Outbreak investigation of Pseudomonas aeruginosa infections in a neonatal intensive care unit

A Pseudomonas aeruginosa outbreak was investigated in a neonatal intensive care unit that had experienced a prior similar outbreak. The 8 cases identified included 2 deaths. An investigation found the cause of the outbreak: tap water from contaminated hospital plumbing which was used for humidifier reservoirs, neonatal bathing, and nutritional preparation. Our findings reinforce a recent Centers for Medicare & Medicaid Services memo recommending increased attention to water management to improve awareness, identification, mitigation, and prevention of water-associated, health care-associated infections.

Pseudomonas aeruginosa Outbreak in a Neonatal Intensive Care Unit Attributed to Hospital Tap Water

OBJECTIVE To investigate an outbreak of Pseudomonas aeruginosa infections and colonization in a neonatal intensive care unit. DESIGN Infection control assessment, environmental evaluation, and case-control study. SETTING Newly built community-based hospital, 28-bed neonatal intensive care unit. PATIENTS Neonatal intensive care unit patients receiving care between June 1, 2013, and September 30, 2014. METHODS Case finding was performed through microbiology record review. Infection control observations, interviews, and environmental assessment were performed. A matched case-control study was conducted to identify risk factors for P. aeruginosa infection. Patient and environmental isolates were collected for pulsed-field gel electrophoresis to determine strain relatedness. RESULTS In total, 31 cases were identified. Case clusters were temporally associated with absence of point-of-use filters on faucets in patient rooms. After adjusting for gestational age, case patients were more likely to have been in a room without a point-of-use filter (odds ratio [OR], 37.55; 95% confidence interval [CI], 7.16-∞). Case patients had higher odds of exposure to peripherally inserted central catheters (OR, 7.20; 95% CI, 1.75-37.30) and invasive ventilation (OR, 5.79; 95% CI, 1.39-30.62). Of 42 environmental samples, 28 (67%) grew P. aeruginosa. Isolates from the 2 most recent case patients were indistinguishable by pulsed-field gel electrophoresis from water-related samples obtained from these case-patient rooms. CONCLUSIONS This outbreak was attributed to contaminated water. Interruption of the outbreak with point-of-use filters provided a short-term solution; however, eradication of P. aeruginosa in water and fixtures was necessary to protect patients. This outbreak highlights the importance of understanding the risks of stagnant water in healthcare facilities. Infect Control Hosp Epidemiol 2017;38:801-808.

Outbreak of Pseudomonas aeruginosa infections in a neonatal care unit associated with feeding bottles heaters

This report describes an outbreak caused by Pseudomonas aeruginosa in a neonatal care unit possibly linked to feeding bottles heaters. Infection control measures were undertaken such as reinforcement of contact isolation precautions, environmental microbiologic sampling, educational sessions on hand hygiene, and use of sterilized water to refill feeding bottles heaters. The sustained eradication of P aeruginosa isolates after implementing control measures on feeding bottles heaters strongly suggests those as the source of the outbreak.

Contaminated feeding bottles: the source of an outbreak of Pseudomonas aeruginosa infections in a neonatal intensive care unit

BACKGROUND

Outbreaks of Pseudomonas aeruginosa have been reported in relationship with contamination of staff fingernails, hands, water baths, hand lotions and others. To our knowledge, contamination of milk and feeding bottles as a source of an outbreak of P aeruginosa infections has not been reported. The incidence of P aeruginosa infection/colonization in our neonatal intensive care unit increased from 1.9 per 1000 patient-days in August 2004 to 8.8 per 1000 patient-days in September 2004.

METHODS

Samples were collected including hand and body lotions, water from the incubator humidifying system, the health care worker hands, and the feeding bottle preparation room. Strains were epidemiologically characterized by pulsed-field gel electrophoresis of SpeI-digested genomic DNA. P aeruginosa was isolated from a total of 30 neonates during the period September 2004 to December 2004.

RESULTS

All cultures (139) of hand and body lotions, water from the incubator humidifying system, and hands of health care personnel were negative. Nine out of 48 samples collected from the feeding bottle preparation room were positive for P aeruginosa (6 samples of in-house prepared milk and 3 samples of water from dishwashers). Pulsed-field gel electrophoresis with SpeI showed that the strains isolated from neonates and from environmental samples were identical. Discontinuation of in-house preparation of feeding bottles and incorporation of unidose milk bottles stopped the outbreak.

CONCLUSION

The preparation and solution of milk from multidose powder preparation may be a source of P aeruginosa infections in a neonatal intensive care unit. The use of manufactured, nonmanipulated, unidose feeding bottles should be considered more adequate.

Nosocomial colonization due to imipenem-resistant Pseudomonas aeruginosa epidemiologically linked to breast milk feeding in a neonatal intensive care unit

AIM

We describe a one-year investigation of colonization by imipenemresistant, metallo-beta-lactamase (MBL) producing Pseudomonas aeruginosa in a neonatal intensive care unit (NICU) of the University Hospital of Palermo, Italy.

METHODS

A prospective epidemiological investigation was conducted in the period 2003 January to 2004 January. Rectal swabs were collected twice a week from all neonates throughout their NICU stay. MBL production by imipenem-resistant strains of P aeruginosa was detected by phenotypic and molecular methods. Pulsed field gel electrophoresis (PFGE) was carried out on all isolates of P aeruginosa. The association between risk factors and colonization by imipenem-resistant, imipenem-susceptible P aeruginosa isolates and other multidrug-resistant Gram negative (MDRGN) organisms was analyzed for variables present at admission and during the NICU stay. Data analysis was carried out by the Cox proportional hazards regression model.

RESULTS

Twentytwo of 210 neonates were colonized with imipenem-resistant, MBL-producing P aeruginosa isolates and 14 by imipenem-susceptible P aeruginosa isolates. A single pulsotype, named A, was shared by all imipenem-resistant isolates. Colonization by P aeruginosa of pulsotype A was positively correlated with breast milk feeding and administration of ampicillin-sulbactam, and inversely correlated with exclusive feeding by formula. In the Cox proportional hazards regression model, birthweight of more than 2500 g and breast milk feeding were independently associated with an increased risk of colonization by MBL producing P aeruginosa.

CONCLUSION

The results strongly support an association between colonization by a well-defined imipenem-resistant, MBL producing P aeruginosa strain and breast milk feeding. Such a study may highlight the need for implementation of strategies to prevent expressed breast milk from becoming a vehicle of health care-associated infections.

[Pseudomonas aeruginosa infections in a neonatal care unit at Reunion Island]

OBJECTIVE

To investigate an outbreak of Pseudomonas aeruginosa (PA) hospital-acquired infections in neonates.

METHODS

Incidences were assessed retrospectively in the neonatal care units of the Groupe Hospitalier Sud-Réunion, from January 2003 to September 2005. Environmental survey, audit of health care workers and case-control study were performed to reinforce staff training and to determine risk factors.

RESULTS

Of 1432 neonates, 40 were infected (median gestational age: 29 weeks, median birth weight: 1195 g), accounting for an attack rate of 2.8%. Between January 2003 and January 2004, incidence rates were less than 2 infections per 1000 hospitalisation days. In the last trimester of year 2004, the incidence rose to 5.6 infections per 1000 hospitalisation days and PA was found in all ocular swabs, leading to diagnose an epidemic. However, it was only 3 months later, after 3 new deaths of very preterm neonates, that the implementation of control measures and an audit of health care practices focused on water utilisation ruled out the outbreak. The overall fatality rate was 25%, and of 71% in severe diseases (septicemia or pneumonia). The epidemic pattern argued for a common unique source. Two risk factors were identified by logistic regression: exposure to mechanical ventilation beyond 4 days (OR 3.3; CI 95%: 1.3-8.4) and very preterm birth (OR 2.7; CI 95%: 1.0-7.7).

CONCLUSION

Our findings highlight the need for a close collaboration between neonatologists and hygienists to improve health care practices and surveillance.

Sustained reductions in neonatal nosocomial infection rates following a comprehensive infection control intervention

OBJECTIVE

Nosocomial infections (NI) are a frequent and important cause of morbidity and mortality in newborn infants who receive intensive care. We sought to determine if comprehensive infection control (CIC) measures decrease rates in a large neonatal intensive care nursery.

METHODS

Single center interventional study. The CIC intervention consisted of increasing nursing and physician education and awareness of infection rates, establishing common improvement goals, training in hand and environment care, and implementing a specialty nursing team for central venous and arterial catheter care. Demographic and microbiology information for all infants admitted to the NICU from January 1, 1999 to December 31, 2000 established baseline data. The intervention period was during January and February 2001. The postintervention period was March 1, 2001 to February 29, 2004. The main outcome measure was the rate of blood, cerebrospinal and/or urinary tract bacterial infections per 1000 hospital days.

RESULTS

Baseline infection rate was 8.5 per 1000 hospital days. The NI rate fell 26% (P=0.002) from baseline in the first year and 29% (P<0.001) in the second and third years after the CIC intervention. The reduction in total NI was due mostly to a 46% fall in coagulase-negative Staphylococcus infection rate (P<0.001); however, rates of all other organisms also fell by 21% (P=0.05).

CONCLUSIONS

CIC measures can reduce bacterial and fungal NI rates. This effect has been sustained for 3 years following the intervention.

Antibiotic resistance: is the end of an era near?

Any attempt to shape the world and modify human personality in order to create a self-chosen pattern of life involves many unknown consequences. Human destiny is bound to remain a gamble, because at some unpredictable time and in some unforeseen manner, nature will strike back.

Use of DNA fingerprinting in decision making for considering closure of neonatal intensive care units because of Pseudomonas aeruginosa bloodstream infections

BACKGROUND

Bloodstream infections with Pseudomonas aeruginosa have been well-described in neonatal intensive care units (NICU) and have resulted in the temporary closure of some nurseries to new admissions. Nosocomial transmission of these infections has been verified by fingerprint analysis of the isolates. We utilized molecular fingerprinting to identify the source of bloodstream infections in an NICU and used this information to apply infection control measures that allowed the nursery to stay open and continue to accept referrals.

METHODS

In June 1998 three premature infants transferred to our hospital (Hospital A) from Hospitals B and C had bloodstream infections with P. aeruginosa. Subsequently one additional neonate transferred from Hospital B was colonized with P. aeruginosa. Random amplification of polymorphic deoxyribonucleic acid (RAPD) was performed on the four isolates. All transfers from Hospital B were cultured, and surveillance programs were instituted in Hospitals A and B. Targeted infection control measures for all transfers were implemented.

RESULTS

The four isolates were the same clone by RAPD. Investigation of the environment in Hospital A did not identify any source of the organism. Surveillance cultures on 49 neonates at Hospital A revealed only one patient colonized at an endotracheal tube. This patient was also a transfer from Hospital B. Results from Hospital B identified 4 of 40 (10%) neonates colonized. All isolates were clones identical with the bloodstream isolates from the neonates with bloodstream infections. Infection control measures for all babies transferred from Hospital B resulted in no new cases of P. aeruginosa bacteremia during the next 5 years.

CONCLUSIONS

The use of molecular fingerprinting of isolates of P. aeruginosa allowed for a prompt and directed infection control plan to be implemented in Hospitals A and B. It also allowed the NICU in Hospital A to continue to accept referrals from other hospitals and to implement a targeted infection control plan for patients transferred from Hospital B.