Outbreak of multidrug-resistant Escherichia coli sequence type 131 in a neonatal intensive care unit: efficient active surveillance prevented fatal outcome.
BACKGROUND
Outbreaks of infections with multidrug-resistant bacteria in neonatal intensive care units (NICUs) pose a major threat, especially to extremely preterm infants. This study describes a 35-day outbreak of multidrug-resistant Escherichia coli (E. coli) in a tertiary-level NICU in Germany.


OBJECTIVE
To underline the importance of surveillance policies in the particularly vulnerable cohort of preterm infants and to describe the efficacy of outbreak control strategies.


METHODS
Data were collected retrospectively from medical reports. Infants and environment were tested for E. coli.


RESULTS
The outbreak affected a total of 13 infants between 25(+1) and 35(+0) weeks of gestation with seven infants showing signs of infection. The outbreak strain was identified as E. coli sequence type 131. Environmental screening provided no evidence for an environmental source. Through colonization surveillance and immediate and adequate treatment of potentially infected preterm infants, no fatalities occurred. Outbreak control was achieved by strict contact precautions, enhanced screening and temporary relocation of the NICU. Relocation and reconstruction improved the NICU's structural layout, focusing on isolation capacities. Follow-up indicated carriage for several months in some infants.


CONCLUSIONS
Routine surveillance allowed early detection of the outbreak. The identification of carriers of the outbreak strain was successfully used to direct antibiotic treatment in case of infection. Enhanced hygienic measures and ward relocation were instrumental in controlling the outbreak.
Children's Hospital, University Hospital Würzburg, Würzburg, Germany. Electronic address: silwedel_c@ukw.de.
C
C
Silwedel
Institute for Hygiene and Microbiology, University of Würzburg, Germany.
U
U
Vogel
Institute for Hygiene and Microbiology, University of Würzburg, Germany.
H
H
Claus
Children's Hospital, University Hospital Würzburg, Würzburg, Germany.
K
K
Glaser
Children's Hospital, University Hospital Würzburg, Würzburg, Germany.
C P
CP
Speer
Children's Hospital, University Hospital Würzburg, Würzburg, Germany.
J
J
Wirbelauer
D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D062665:Epidemiological Monitoring; D004926:Escherichia coli / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005838:Genotype; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D007363:Intensive Care Units, Neonatal; D008297:Male; D058885:Multilocus Sequence Typing; D000071074:Neonatal Sepsis / Q000453:epidemiology*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome
E. coli ST131; Outbreak; Preterm; Ward closure