Enterobacterial repetitive intergenic consensus polymerase chain reaction typing of isolates of Enterobacter cloacae from an outbreak of infection in a neonatal intensive care unit.
BACKGROUND
Enterobacter cloacae has become a common cause of nosocomial infections. This study was designed to investigate the pattern of spread of E cloacae during an outbreak in a neonatal intensive care unit.


METHODS
Enterobacterial repetitive intergenic consensus polymerase chain reaction was used to examine 111 E cloacae isolates from 17 patients, including 81 from surveillance cultures, 23 from endotracheal tubes, 3 from eyes, and 1 each from blood, urine, skin, and throat. Antibiotic susceptibility profiles were also obtained.


RESULTS
Infection with E cloacae resulted from endogenous bacteria and from horizontal transmission. One group of 61 isolates, a third of which were obtained from clinical specimens, was uniformly susceptible to imipenem and ciprofloxacin only. A second group of 50 isolates, only 18% of which were obtained from clinical specimens, was susceptible to all antibiotics tested except for aminopenicillins and first-generation cephalosporins.


CONCLUSIONS
These data indicate that (1) patient-to-patient spread is an important cause of E cloacae infection in the neonatal intensive care unit and (2) highly antibiotic-resistant E cloacae may emerge during an outbreak.
Peters
S M
SM
Department of Microbiology and Immunology, Georgetown University Medical Center, Washington, DC 20007, USA.
Bryan
J
J
Cole
M F
MF
D000046:Academic Medical Centers; D016000:Cluster Analysis; D016384:Consensus Sequence; D003428:Cross Infection / Q000382:microbiology* / Q000635:transmission*; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics*; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D018562:Disease Transmission, Infectious / Q000706:statistics & numerical data*; D004219:District of Columbia; D004352:Drug Resistance, Microbial; D016972:Enterobacter cloacae / Q000145:classification* / Q000235:genetics*; D004756:Enterobacteriaceae Infections / Q000382:microbiology* / Q000635:transmission*; D014644:Genetic Variation; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007363:Intensive Care Units, Neonatal; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction / Q000379:methods*; D015995:Prevalence; D012703:Serotyping
D004269:DNA, Bacterial