title: Infection due to extended-spectrum beta-lactamase-producing Salmonella enterica subsp. enterica serotype infantis in a neonatal unit.
abstract: OBJECTIVE
  To describe the investigation and control of an outbreak of extended-spectrum beta-lactamase producing Salmonella enterica subsp. enterica serotype Infantis in a neonatal unit in Brazil.
  
  
  METHODS
  A case-control study for risk factors for Salmonella Infantis systemic infection, environmental cultures, and evaluation of staffing and overcrowding and an assessment of infection control practices were performed.
  
  
  RESULTS
  During July 1998 to June 1999, 140 Salmonella Infantis culture-positive patients were identified in the neonatal unit. Presence of a peripheral intravascular catheter was identified as an independent risk factor (odds ratio = 4.98; 95% CI = 1.59-19.31; P =.01) and each 250-g increase in birth weight as a protective factor (odds ratio = 0.76; 95% CI = 0.57-0.95; P =.03). Hospital stay was significantly longer and costs higher in case patients than in control patients. Salmonella Infantis was isolated from multiple environmental sources. Neonatal unit personnel were observed to make several breaks in infection control practices. The unit was understaffed and overcrowded. Prompt case identification, cohorting of patients, enhanced staff hand hygiene, and environmental cleaning terminated the outbreak.
  
  
  CONCLUSIONS
  Inadequate infection control practices, nursery overcrowding, and understaffing can have an adverse effect on patient morbidity, mortality rates, and hospital cost.
authors.affiliation: Universidade do Rio de Janeiro, Instituto Municipal da Mulher Fernando Magalhães, and Universidade de Rio de Janeiro Brazil.
authors.forename: Carmem Lúcia
authors.initials: CL
authors.lastname: Pessoa-Silva
authors.forename: Cristiana M
authors.initials: CM
authors.lastname: Toscano
authors.forename: Beatriz Meurer
authors.initials: BM
authors.lastname: Moreira
authors.forename: Ana Lúcia
authors.initials: AL
authors.lastname: Santos
authors.forename: Ana Cristina Cisne
authors.initials: AC
authors.lastname: Frota
authors.forename: Claude Andre
authors.initials: CA
authors.lastname: Solari
authors.forename: Efigênia L t
authors.initials: EL
authors.lastname: Amorim
authors.forename: Maria Da Gloria S
authors.initials: Mda G
authors.lastname: Carvalho
authors.forename: Lúcia Martins
authors.initials: LM
authors.lastname: Teixeira
authors.forename: William R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D012480:Salmonella Infections / Q000453:epidemiology / Q000517:prevention & control*; D019779:Salmonella enterica; D018709:Statistics, Nonparametric; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases