Enterobacter cloacae colonisation and infection in a neonatal intensive care unit: retrospective investigation of preven
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RESEARCH ARTICLE
Open Access
Enterobacter cloacae colonisation and infection in a neonatal intensive care unit: retrospective investigation of preventive measures implemented after a multiclonal outbreak Alexandrine Ferry1, Frank Plaisant1, Christophe Ginevra2, Yann Dumont2, Jacqueline Grando2, Olivier Claris1,3, François Vandenesch2,4 and Marine Butin1,4*
Abstract Background: Enterobacter cloacae species is responsible for nosocomial outbreaks in vulnerable patients in neonatal intensive care units (NICU). The environment can constitute the reservoir and source of infection in NICUs. Herein we report the impact of preventive measures implemented after an Enterobacter cloacae outbreak inside a NICU. Methods: This retrospective study was conducted in one level 3 NICU in Lyon, France, over a 6 year-period (2012– 2018). After an outbreak of Enterobacter cloacae infections in hospitalized neonates in 2013, several measures were implemented including intensive biocleaning and education of medical staff. Clinical and microbiological characteristics of infected patients and evolution of colonization/infection with Enterobacter spp. in this NICU were retrieved. Moreover, whole genome sequencing was performed on 6 outbreak strains. Results: Enterobacter spp. was isolated in 469 patients and 30 patients developed an infection including 2 meningitis and 12 fatal cases. Preventive measures and education of medical staff were not associated with a significant decrease in patient colonisation but led to a persistent decreased use of cephalosporin in the NICU. Infection strains were genetically diverse, supporting the hypothesis of multiple hygiene defects rather than the diffusion of a single clone. Conclusions: Grouped cases of infections inside one setting are not necessarily related to a single-clone outbreak and could reveal other environmental and organisational problematics. The fight against implementation and transmission of Enterobacter spp. in NICUs remains a major challenge. Keywords: Enterobacter cloacae, NICU, Outbreak, Cephalosporins, Biocleaning
* Correspondence: [email protected] 1 Hospices Civils de Lyon, Service de Néonatologie et Réanimation Néonatale, Hôpital Femme Mère 59 Boulevard Pinel, 69500 Bron, France 4 CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1; CNRS, UMR5308, Lyon, France Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If
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