title: Long term epidemiological analysis of Citrobacter diversus in a neonatal intensive care unit.
abstract: A prolonged outbreak of Citrobacter diversus central nervous system infection among hospitalized term infants, peaking in 1979, ceased with establishment of nurse-patient cohorting. The outbreak was attributed to dissemination of an epidemic strain among infants in an antiquated neonatal intensive care unit. When C. diversus colonization recurred within the new neonatal intensive care unit in 1984, cohorting and bacteriologic surveillance were reinstituted. By utilizing biotypes, plasmid profiles and antibiograms, four different C. diversus strains were identified circulating during 1979. Strains recovered between 1984 and 1988 from neonatal intensive care unit infants were similar to those from community-acquired sources. A strain considered avirulent in 1979 was found causing bacteremia in two infants (one with central nervous system disease) in 1984 to 1988. During cohorting C. diversus acquisition was 0.019/patient-month; after cohorting ceased it was 0.017/patient-month. Multiple source introductions appeared to occur with different C. diversus strains, some causing infant disease. No efficacy of cohorting was evident.
authors.affiliation: Department of Medical Microbiology, Creighton University School of Medicine, Omaha, NE 68178.
authors.forename: R V
authors.initials: RV
authors.lastname: Goering
authors.forename: N J
authors.initials: NJ
authors.lastname: Ehrenkranz
authors.forename: C C
authors.initials: CC
authors.lastname: Sanders
authors.forename: W E
authors.initials: WE
authors.lastname: Sanders
mesh_terms: D002954:Citrobacter / Q000145:classification / Q000302:isolation & purification; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D005431:Florida / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D011321:Primary Nursing; D013045:Species Specificity