Infection due to extended-spectrum beta-lactamase-producing Salmonella enterica subsp. enterica serotype infantis in a neonatal unit.
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.
Pessoa-Silva
Carmem Lúcia
CL
Universidade do Rio de Janeiro, Instituto Municipal da Mulher Fernando Magalhães, and Universidade de Rio de Janeiro Brazil.
Toscano
Cristiana M
CM
Moreira
Beatriz Meurer
BM
Santos
Ana Lúcia
AL
Frota
Ana Cristina Cisne
AC
Solari
Claude Andre
CA
Amorim
Efigênia L t
EL
Carvalho
Maria Da Gloria S
Mda G
Teixeira
Lúcia Martins
LM
Jarvis
William R
WR
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*
D001618:beta-Lactamases