J Pediatr Infect Dis 2019; 14(05): 223-227
DOI: 10.1055/s-0039-1691780
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Nosocomial Infection Outbreak with Enterobacter aerogenes at a Neonatal Intensive Care Unit and Its Outcomes

Dilek Ulubaş Işık
1  Etlik Zübeyde Hanım Women’s Health Teaching and Research Hospital, University of Health Sciences, Ankara, Turkey
,
Ahmet Yagmur Bas
2  Department of Neonatology, Yildirim Beyazit University Medical Faculty, Ankara, Turkey
,
Ferit Kulali
1  Etlik Zübeyde Hanım Women’s Health Teaching and Research Hospital, University of Health Sciences, Ankara, Turkey
,
Beyza Ozcan
3  Konya Teaching and Research Hospital, University of Health Sciences, Konya, Turkey
,
Sezin Unal
1  Etlik Zübeyde Hanım Women’s Health Teaching and Research Hospital, University of Health Sciences, Ankara, Turkey
,
Husniye Yucel
1  Etlik Zübeyde Hanım Women’s Health Teaching and Research Hospital, University of Health Sciences, Ankara, Turkey
,
Nihal Demirel
2  Department of Neonatology, Yildirim Beyazit University Medical Faculty, Ankara, Turkey
› Author Affiliations
Further Information

Publication History

11 October 2018

17 April 2019

Publication Date:
28 May 2019 (eFirst)

Abstract

Objective Health care associated infections (HAIs) in the neonatal intensive care unit (NICU) are a significant cause of neonatal morbidity and mortality. Enterobacter aerogenes, a gram-negative bacterium, rarely causes HAI in the pediatric and NICUs. We report the case of a HAI outbreak of E. aerogenes in an NICU and discuss the clinical spectrum and outcome of the affected preterm newborns and successful prevention measures.

Materials and Methods A retrospective study was conducted in a level III NICU of Etlik Zubeyde Hanım Women's Health Teaching and Research Hospital. The infants with blood cultures positive for E. aerogenes during the outbreak were enrolled. Perinatal risk factors, laboratory findings, symptoms, treatment, and prognosis were recorded. Clinical applications and prevention measures were identified.

Results A preterm infant of 27 weeks of gestation who was diagnosed on the eighth postnatal day was the initial case of the reported outbreak of health care associated E. aerogenes infection. Subsequently, 12 more infants were diagnosed in the next 3 months. Infants' mean gestational age was 27.1 ± 2.3 weeks, and mean birthweight was 902 ± 161 g. The clinical symptoms at presentation were respiratory distress, sclerema, circulatory failure, and shock, which appeared at a mean age of 7.6 ± 5.8 days. Analysis of E. aerogenes strains revealed that all strains were of the same clonal type. Eight patients died in follow-up due to E. aerogenes septicemia during this outbreak. The mean interval between the onset of symptoms and death was 1.5 ± 1 days.

Conclusion Outbreaks of health care associated E. aerogenes infection result in a high mortality rate among very low birthweight infants. Awareness of adjustable risk factors and preventive measures to control the outbreak decreases both morbidity and mortality.