title: Nosocomial transmission of group B streptococci proven by positive environmental culture.
abstract: OBJECTIVE
  Neonates usually acquire Group B streptococcal infection vertically from the maternal birth canal during delivery. In January 2010, a Group B streptococcal outbreak investigation was conducted in response to an increased number of clinical specimens from our neonatal intensive care unit.
  
  
  METHODS
  Microbiology laboratory records were reviewed to identify Group B streptococcal from specimens originating from the neonatal intensive care unit during December 2009 and January 2010. Patients from whom these specimens were collected were identified and their charts reviewed. Environmental samples to screen for Group B streptococcal were collected from the unit, clinical and environmental isolates were compared by pulsed field gel electrophoresis. Point prevalence screening was conducted twice before declaring the outbreak over.
  
  
  RESULTS
  Pulsed field gel electrophoresis patterns of three clinical strains from six patients were indistinguishable. One environmental strain was isolated from one of the patients monitor, and had identical pulsed field gel electrophoresis pattern to that of the three clinical strains. Infection control measures were implemented in the neonatal intensive care unit and follow-up point prevalence screening identified no new cases.
  
  
  CONCLUSIONS
  Although poor infection control practice has been implicated in previous reports of nosocomial outbreaks of Group B streptococcal infection in neonatal intensive care units, our finding provides unique evidence that the environment can act as a reservoir of Group B streptococcal and play a key role in nosocomial transmission.
authors.affiliation: Division of Infectious Diseases, Child Health Department, Royal Hospital, P.O Box 1131, Seeb Airport 111, Oman.
authors.forename: Amal
authors.initials: A
authors.lastname: Al-Maani
authors.affiliation: Infection Prevention and Control Department, The Hospital for Sick Children, Toronto, Ontario.
authors.forename: Laurie
authors.initials: L
authors.lastname: Streitenberger
authors.affiliation: Infection Prevention and Control Department, The Hospital for Sick Children, Toronto, Ontario.
authors.forename: Megan
authors.initials: M
authors.lastname: Clarke
authors.affiliation: Division of Microbiology, The Hospital of Sick Children, Toronto, Ontario.
authors.forename: Yvonne C W
authors.initials: YC
authors.lastname: Yau
authors.affiliation: Division of Microbiology, The Hospital of Sick Children, Toronto, Ontario.
authors.forename: Danuta
authors.initials: D
authors.lastname: Kovach
authors.affiliation: Infection Prevention and Control Department, The Hospital for Sick Children, Toronto, Ontario.
authors.forename: Rick
authors.initials: R
authors.lastname: Wray
authors.affiliation: Infection Prevention and Control Department, The Hospital for Sick Children, Toronto, Ontario.
authors.forename: Anne
authors.initials: A
authors.lastname: Matlow
keywords: Environment; Group B streptococcus; NICU; Neonates; Outbreak; Pulsed field gel electrophoresis (PFGE); Streptococcus agalactiae