Clustering of Enterococcus faecalis infections in a cardiology hospital neonatal intensive care unit

Abstract

Early identification of an outbreak is one of the main advantages of routine epidemiological surveillance. Enterococcus spp. used to be regarded as microorganisms of low pathogenicity, because they are part of the normal microbial flora of the gastrointestinal and genitourinary tract. Recently, they have emerged as important pathogenic agents, sometimes causing infections with high mortality rates. We studied a clustering of primary bloodstream infections caused by Enterococcus faecalis in a cardiology hospital neonatal intensive care unit (NICU). Four cases of primary bloodstream infection by E. faecalis were detected from April 15 to May 13, 2004, during active infection surveillance. The isolates were sensitive to glycopeptides. Some aspects of the management of these patients, including the date of insertion and placement of a central venous catheter, prescription of a specific medication, contiguity of beds, personnel attending the patients, and occurrence of diarrhea were analyzed to look for factors that might affect the spread of the microorganisms. Measures taken to hamper the spread included contact precautions throughout the unit, cleansing and disinfection of equipment and surfaces, bathing children with 2% chlorhexidine-gluconate-containing soap, professional reeducation, and reinforcement of all measures to prevent infections. We suggest that there is a need to re-evaluate preventive infection measures and to review the strategies aimed at decreasing the nosocomial infection rate in the NICU.

Epidemiology and healthcare factors associated with neonatal enterococcal infections

“…While patient risk factors for nosocomial infection are well known (eg, prematurity, invasive procedures),4 further investigation of healthcare risk factors is required. Increased admissions, infrastructural changes, excessive workload and understaffing are healthcare factors which have been associated with an increased risk of infections 5–9…”

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

“…A search of the literature references revealed only 2 outbreak articles with VSEfe in a neonatal setting, and both outbreaks were discovered from blood cultures. 2,3 In total, 4 neonates were identified with bacteremia in 2004 during a 1-month active surveillance in a 10-bed NICU cardiology service in Brazil. 3 All neonates had a CVC that breached the skin barrier, which was believed to be the portal of entry of VSEfe from the skin environment, especially because episodes of Rotavirus diarrhea had been reported in the NICU.…”

“…2,3 In total, 4 neonates were identified with bacteremia in 2004 during a 1-month active surveillance in a 10-bed NICU cardiology service in Brazil. 3 All neonates had a CVC that breached the skin barrier, which was believed to be the portal of entry of VSEfe from the skin environment, especially because episodes of Rotavirus diarrhea had been reported in the NICU. A combination of infection control measures were implemented to reinforce measures to prevent further infections: enhanced environmental cleaning, unit layout modifications, neonatal bathing with chlorhexidine-gluconate soap, and increased nursing ratios.…”

“…1 Published outbreaks in neonatal units are usually associated with vancomycin-resistant E. faecium, although a few outbreaks have been attributed to vancomycin-sensitive E. faecalis (VSEfe). 2,3 The neonatal infection surveillance network (neonIN; www.neonin.org.uk) has collected data on invasive neonatal infections from 60 participating units across Europe and Australia (including Monash Newborn (MNB), Monash Children's Hospital) since 2004. Enterococcus spp were the second most common cause of infections from blood, cerebrospinal fluid, or urine in neonates after 48 hours post delivery.…”

Infecções relacionadas à assistência em saúde em unidades de terapia intensiva neonatal: uma revisão integrativa

“…Sin embargo, en los últimos años, ha causado infecciones y aumentado las tasas de mortalidad. Así, se han redoblado las medidas de prevención y control de las IRAS como precauciones de contacto, limpieza y desinfección adecuada de equipos y superficies, baño del RN con clorhexidina-gluconato al 2%, reeducación de los profesionales y refuerzo de las medidas de prevención 34 .…”