Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-18T23:31:17.152Z Has data issue: false hasContentIssue false
  • English
  • Français

A nonclonal outbreak of vancomycin-sensitive Enterococcus faecalis bacteremia in a neonatal intensive care unit

Published online by Cambridge University Press:  05 August 2019

Despina Kotsanas ,
Kenneth Tan ,
Carmel Scott ,
Britta Baade ,
Michaela Hui Ling Cheng ,
Zien Vanessa Tan ,
Jacqueline E. Taylor ,
Jason C. Kwong ,
Torsten Seemann  and
Geoffrey W. Coombs
...Show all authors
Despina Kotsanas*
Affiliation:
Monash Infectious Diseases, Monash Medical Centre, Clayton, Victoria, Australia
Kenneth Tan
Affiliation:
Monash Newborn, Monash Children’s Hospital, Clayton, Victoria, Australia Department of Paediatrics, Monash University, Clayton, Victoria, Australia
Carmel Scott
Affiliation:
Infection Control, Monash Medical Centre, Clayton, Victoria, Australia
Britta Baade
Affiliation:
Monash Newborn, Monash Children’s Hospital, Clayton, Victoria, Australia
Michaela Hui Ling Cheng
Affiliation:
Department of Paediatrics, Monash University, Clayton, Victoria, Australia
Zien Vanessa Tan
Affiliation:
Department of Paediatrics, Monash University, Clayton, Victoria, Australia
Jacqueline E. Taylor
Affiliation:
Monash Newborn, Monash Children’s Hospital, Clayton, Victoria, Australia
Jason C. Kwong
Affiliation:
Department of Microbiology and Immunology, The University of Melbourne, Parkville, Victoria, Australia
Torsten Seemann
Affiliation:
Department of Microbiology and Immunology, The University of Melbourne, Parkville, Victoria, Australia
Geoffrey W. Coombs
Affiliation:
Antimicrobial Resistance and Infectious Diseases (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
Benjamin P. Howden
Affiliation:
Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
Rhonda L. Stuart
Affiliation:
Monash Infectious Diseases, Monash Medical Centre, Clayton, Victoria, Australia Department of Medicine, Monash University, Victoria, Australia
*
Author for correspondence: Despina Kotsanas, Monash Infectious Diseases, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia. E-mail: despina.kotsanas@monashhealth.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe an outbreak of bacteremia caused by vancomycin-sensitive Enterococcus faecalis (VSEfe).

Design:

An investigation by retrospective case control and molecular typing by whole-genome sequencing (WGS).

Setting:

A tertiary-care neonatal unit in Melbourne, Australia.

Methods:

Risk factors for 30 consecutive neonates with VSEfe bacteremia from June 2011 to December 2014 were analyzed using a case control study. Controls were neonates matched for gestational age, birth weight, and year of birth. Isolates were typed using WGS, and multilocus sequence typing (MLST) was determined.

Results:

Bacteremia for case patients occurred at a median time after delivery of 23.5 days (interquartile range, 14.9–35.8). Previous described risk factors for nosocomial bacteremia did not contribute to excess risk for VSEfe. WGS typing results designated 43% ST179 as well as 14 other sequence types, indicating a polyclonal outbreak. A multimodal intervention that included education, insertion checklists, guidelines on maintenance and access of central lines, adjustments to the late onset sepsis antibiotic treatment, and the introduction of diaper bags for disposal of soiled diapers after being handled inside the bed, led to termination of the outbreak.

Conclusions:

Typing using WGS identified this outbreak as predominately nonclonal and therefore not due to cross transmission. A multimodal approach was then sought to reduce the incidence of VSEfe bacteremia.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 10 , October 2019 , pp. 1116 - 1122
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. Part of this study was presented in a poster at the Perinatal Society of Australia and New Zealand 2015 conference as preliminary case control findings: “Investigating Risk Factors for Enterococcal Bacteraemia in the NICU—A case control study,” on May 25, 2016, at Townsville, Queensland, Australia.

References

Arias, CA, Murray, BE. The rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol 2012;10:266–278.CrossRefGoogle ScholarPubMed
Softic, I, Tahirovic, H, Di Ciommo, V, Auriti, C. Bacterial sepsis in neonates: Single centre study in a neonatal intensive care unit in Bosnia and Herzegovina. Acta Med Acad 2017;46:7–15.CrossRefGoogle Scholar
Strabelli, TM, Cais, DP, Zeigler, R, et al. Clustering of Enterococcus faecalis infections in a cardiology hospital neonatal intensive care unit. Braz J Infect Dis 2006;10:113–116.CrossRefGoogle Scholar
Wang, J, Kortsalioudaki, C, Heath, PT, et al. Epidemiology and healthcare factors associated with neonatal enterococcal infections. Arch Dis Child Fetal Neonat 2018. doi: 10.1136/archdischild-2018-315387.CrossRefGoogle Scholar
Samanta, S, Farrer, K, Breathnach, A, Heath, PT. Risk factors for late onset gram-negative infections: a case-control study. Arch Dis Child Fetal Neonat 2011;96:F15–F18.CrossRefGoogle ScholarPubMed
Ruiz-Garbajosa, P, Bonten, MJ, Robinson, DA, et al. Multilocus sequence typing scheme for Enterococcus faecalis reveals hospital-adapted genetic complexes in a background of high rates of recombination. J Clin Microbiol 2006;44:2220–2228.CrossRefGoogle Scholar
Lister, DM, Kotsanas, D, Ballard, SA, et al. Outbreak of vanB vancomycin-resistant Enterococcus faecium colonization in a neonatal service. Am J Infect Control 2015;43:1061–1065.CrossRefGoogle Scholar
Gillespie, E, Tabbara, L, Scott, C, Lovegrove, A, Kotsanas, D, Stuart, RL. Microfiber and steam for a neonatal service: an improved and safe cleaning methodology. Am J Infect Control 2017;45:98–100.CrossRefGoogle ScholarPubMed
Taylor, JE, McDonald, SJ, Earnest, A, et al. A quality improvement initiative to reduce central line infection in neonates using checklists. Eur J Pediatr 2017;176:639–646.CrossRefGoogle ScholarPubMed
Gritz, EC, Bhandari, V. The human neonatal gut microbiome: a brief review. Front Pediatr 2015;3:17.Google ScholarPubMed
Mueller, NT, Bakacs, E, Combellick, J, Grigoryan, Z, Dominguez-Bello, MG. The infant microbiome development: mom matters. Trends Molec Med 2015;21:109–117.CrossRefGoogle ScholarPubMed
Younge, NE, Araujo-Perez, F, Brandon, D, Seed, PC. Early-life skin microbiota in hospitalized preterm and full-term infants. Microbiome 2018;6:98.CrossRefGoogle ScholarPubMed
Brooks, B, Olm, MR, Firek, BA, et al. The developing premature infant gut microbiome is a major factor shaping the microbiome of neonatal intensive care unit rooms. Microbiome 2018;6:112.CrossRefGoogle ScholarPubMed
Babu, MC, Tandur, B, Sharma, D, Murki, S. Disposable diapers decrease the incidence of neonatal infections compared to cloth diapers in a level II neonatal intensive care unit. J Trop Pediatr 2015;61:250–254.CrossRefGoogle Scholar
Worth, LJ, Daley, AJ, Spelman, T, Bull, AL, Brett, JA, Richards, MJ. Central and peripheral line-associated bloodstream infections in Australian neonatal and paediatric intensive care units: findings from a comprehensive Victorian surveillance network, 2008–2016. J Hosp Infect 2018;99:55–61.CrossRefGoogle Scholar
Chen, YC, Lin, CF, Rehn, YF, et al. Reduced nosocomial infection rate in a neonatal intensive care unit during a 4-year surveillance period. J Chin Med Assoc 2017;80:427–431.CrossRefGoogle Scholar
Johnson, J, Quach, C. Outbreaks in the neonatal ICU: a review of the literature. Curr Opin Infect Dis 2017;30:395–403.CrossRefGoogle ScholarPubMed
Kwong, JC, McCallum, N, Sintchenko, V, Howden, BP. Whole genome sequencing in clinical and public health microbiology. Pathology 2015;47:199–210.CrossRefGoogle ScholarPubMed
Supplementary material: File

Kotsanas et al. supplementary material

Kotsanas et al. supplementary material
Download Kotsanas et al. supplementary material(File)
File 16.5 KB