Surveillance of Pseudomonas aeruginosa-isolates in a neonatal intensive care unit over a one year-period.
Outbreaks of gram-negative bacteria such as Pseudomonas aeruginosa in neonatal intensive care units (NICU) can be life-threatening to pre-term infants, which are highly susceptible to serious infections with bacteria. Forty-two ventilated neonates in the NICU of the University Children's Hospital of Tuebingen were found to be colonized (n = 40) or infected (n = 2) with P. aeruginosa within a sampling period of one year. To investigate the colonization patterns and identify potential outbreak sources, epidemiological investigations, environmental surveillance and typing by serotyping and pulsed-field gel electrophoresis of the recovered isolates were performed. The investigation demonstrated a genetically related cluster of P. aeruginosa isolates during the surveillance period in 39 neonates and a second cluster at the end of the period in two neonates. A third strain representing a genetically distinct group was found in only one patient. Environmental investigations demonstrated the presence of P. aeruginosa in the ventilation equipment of 22 patients: binasal prongs (n = 22), water reservoir (n = 9), and heater (n = 1). In one case, P. aeruginosa was found in breast milk. Other environmental investigations revealed no P. aeruginosa. Although no evidence for a unique source was found, a series of intervention steps were initiated by the NICU personnel, medical microbiologists and infection control experts. The intervention steps included reinforced training of health care staff and a change from chemical to thermal disinfection of binasal prongs. Implementation of these measurements successfully stopped the recurrent occurrence of P. aeruginosa colonization.
Dep. of Laboratory Medicine, Klinik am Eichert, Göppingen, Germany. lutz.zabel@kae.de
Lutz Thomas
LT
Zabel
Peter
P
Heeg
Rangmar
R
Goelz
D003428:Cross Infection / Q000209:etiology* / Q000517:prevention & control*; D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks; D004203:Disinfection; D016021:Epidemiologic Studies; D005858:Germany; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D017053:Infection Control; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011552:Pseudomonas Infections / Q000209:etiology* / Q000517:prevention & control*; D011550:Pseudomonas aeruginosa / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D012307:Risk Factors; D012703:Serotyping
D004269:DNA, Bacterial