Vancomycin-resistant Enterococcus (VRE) outbreak in a neonatal intensive care unit and special care nursery at a tertiary-care hospital in Australia—A retrospective case-control study

2019 ◽  
Vol 40 (05) ◽  
pp. 551-558 ◽  
Author(s):  
Patiyan Andersson ◽  
Wendy Beckingham ◽  
Claire Louise Gorrie ◽  
Karina Kennedy ◽  
Kathryn Daveson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Case Control Study ◽  
Tertiary Care ◽  
Case Control ◽  
Retrospective Case ◽  
Vancomycin Resistant ◽  
Control Study

AbstractObjective:We investigated the risk factors and origins of the first known occurrence of VRE colonization in the neonatal intensive care unit (NICU) at the Canberra Hospital.Design:A retrospective case-control study.Setting:A 21-bed neonatal intensive care unit (NICU) and a 15-bed special care nursey (SCN) in a tertiary-care adult and pediatric hospital in Australia.Patients:All patients admitted to the NICU and SCN over the outbreak period: January–May 2017. Of these, 14 were colonized with vancomycin-resistant Enterococcus (VRE) and 77 were noncolonized.Methods:Demographic and clinical variables of cases and controls were compared to evaluate potential risk factors for VRE colonization. Whole-genome sequencing of the VRE isolates was used to determine the origin of the outbreak strain.Results:Swift implementation of wide-ranging infection control measures brought the outbreak under control. Multivariate logistic regression revealed a strong association between early gestational age and VRE colonization (odds ratio [OR], 3.68; 95% confidence interval [CI], 1.94–7.00). Whole-genome sequencing showed the isolates to be highly clonal Enterococcus faecium ST1421 harboring a vanA gene and to be closely related to other ST1421 previously sequenced from the Canberra Hospital and the Australian Capital Territory.Conclusion:The colonization of NICU patients was with a highly successful clone endemic to the Canberra Hospital likely introduced into the NICU environment from other wards, with subsequent cross-contamination spreading among the neonate patients. Use of routine surveillance screening may have identified colonization at an earlier stage and have now been implemented on a 6-monthly schedule.

Bacteremia Due to Persistent Strains of Coagulase-Negative Staphylococci in a Neonatal Intensive-Care Unit

1999 ◽  
Vol 20 (05) ◽  
pp. 349-351 ◽  
Author(s):  
Lillian Sung ◽  
Karam Ramotar ◽  
Lindy M. Samson ◽  
Baldwin Toye
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Case Control Study ◽  
Case Control ◽  
Retrospective Case ◽  
Coagulase Negative Staphylococci ◽  
Control Study

AbstractThis retrospective case-control study was performed to determine risk factors for bacteremia due to persistent coagulase-negative staphylococci in our neonatal intensive-care unit. Enteral nutrition and the presence of a nasogastric tube were identified as possible risk factors for coagulase-negative staphylococcal bacteremia involving one of the persistent strains.

Clustering ofSerratia marcescensInfections in a Neonatal Intensive Care Unit

2004 ◽  
Vol 25 (9) ◽  
pp. 723-729 ◽  
Author(s):  
Emmi Sarvikivi ◽  
Outi Lyytikäinen ◽  
Saara Salmenlinna ◽  
Jaana Vuopio-Varkila ◽  
Päivi Luukkainen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Case Control Study ◽  
Tertiary Care ◽  
Case Control ◽  
Pfge Analysis ◽  
Control Study

AbstractObjectives:To study clusters of infections caused bySerratia marcescensin a neonatal intensive care unit (NICU) and to determine risk factors forS. marcescensinfection or colonization.Design:Genotyping ofS. marcescensisolates was performed by pulsed-field gel electrophoresis (PFGE). A retrospective case-control study was conducted.Setting:A tertiary-care pediatric hospital with a 16-bed NICU.Patients:All neonates with at least one culture positive forS. marcescensin the NICU during December 1999 to July 2002. Case-patients (n = 11) treated in the NICU during December 1999 to February 2000 were included in the case-control study. Neonates treated in the NICU for at least 72 hours during the same period with cultures negative forS. marcescenswere used as control-patients (n = 27).Results:S. marcescenswas cultured from 19 neonates; 9 were infected and 10 were colonized. PFGE analysis identified three epidemic strains; each cluster consisted of identical isolates, except one isolate in the first cluster that was different. The risk factors identified were low birth weight, prematurity, prolonged respiratory therapy, prolonged use of antibiotics, and maternal infection prior to delivery. Overcrowding and understaffing were recorded simultaneously with the clusters.Conclusions:PFGE analysis showed three independent clusters. Several factors contributed to spread of the epidemic strains: (1) there were many severely premature and susceptible neonates, (2) the NICU was overcrowded during the clusters, and (3) transmission was likely to occur via the hands of staff. Cohorting and improvement of routine infection control measures led to the cessation of each cluster.

Pseudomonas aeruginosa Outbreak in a Neonatal Intensive Care Unit Attributed to Hospital Tap Water

2017 ◽  
Vol 38 (7) ◽  
pp. 801-808 ◽  
Author(s):  
Cara Bicking Kinsey ◽  
Samir Koirala ◽  
Benjamin Solomon ◽  
Jon Rosenberg ◽  
Byron F. Robinson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Gel Electrophoresis ◽  
Neonatal Intensive Care ◽  
Case Control Study ◽  
Case Control ◽  
Pulsed Field Gel Electrophoresis ◽  
Point Of Use ◽  
Control Study

OBJECTIVETo investigate an outbreak of Pseudomonas aeruginosa infections and colonization in a neonatal intensive care unit.DESIGNInfection control assessment, environmental evaluation, and case-control study.SETTINGNewly built community-based hospital, 28-bed neonatal intensive care unit.PATIENTSNeonatal intensive care unit patients receiving care between June 1, 2013, and September 30, 2014.METHODSCase finding was performed through microbiology record review. Infection control observations, interviews, and environmental assessment were performed. A matched case-control study was conducted to identify risk factors for P. aeruginosa infection. Patient and environmental isolates were collected for pulsed-field gel electrophoresis to determine strain relatedness.RESULTSIn total, 31 cases were identified. Case clusters were temporally associated with absence of point-of-use filters on faucets in patient rooms. After adjusting for gestational age, case patients were more likely to have been in a room without a point-of-use filter (odds ratio [OR], 37.55; 95% confidence interval [CI], 7.16–∞). Case patients had higher odds of exposure to peripherally inserted central catheters (OR, 7.20; 95% CI, 1.75–37.30) and invasive ventilation (OR, 5.79; 95% CI, 1.39–30.62). Of 42 environmental samples, 28 (67%) grew P. aeruginosa. Isolates from the 2 most recent case patients were indistinguishable by pulsed-field gel electrophoresis from water-related samples obtained from these case-patient rooms.CONCLUSIONSThis outbreak was attributed to contaminated water. Interruption of the outbreak with point-of-use filters provided a short-term solution; however, eradication of P. aeruginosa in water and fixtures was necessary to protect patients. This outbreak highlights the importance of understanding the risks of stagnant water in healthcare facilities.Infect Control Hosp Epidemiol 2017;38:801–808

scholarly journals The Association Between Maternal Hypoglycemia on the 75 g Glucose Tolerance Test and Maternal-Neonatal Outcomes: A Matched Case Control Study

2021 ◽  
Author(s):  
Emine Öztürk ◽  
Şükrü Yıldız
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Pregnant Women ◽  
Neonatal Intensive Care ◽  
Case Control Study ◽  
Case Control ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
Control Study

Objective: The aim of this study was to determine whether pregnant women who developed maternal hypoglycemia during the 75 g Oral Glucose Test (OGT) were at an increased risk for adverse obstetric and neonatal outcomes. Methods: This case-control study was conducted from computer-based medical records of women who delivered in a tertiary center between January 2015 and December 2018. OGT had been performed with 75 gr glucose for gestational diabetes screening at 24-28 weeks of gestation. The pregnants with 1st-hour blood glucose levels less than 90 mg/dl (low GT) were matched with normoglycemic patients according to age, body mass index (BMI), gravida and gestational weeks. Obstetric and neonatal outcomes were assessed. Results: Of the 1249 pregnant women included in the study, 62 (4.9%) were in the Low GT group. Admission to the neonatal intensive care unit (NICU) showed a rate of 3.48 increase in the Low GT group (95% confidence interval: 1.05-11.47, p=0.04). There was no difference between the two groups in the other obstetric and neonatal parameters such as: preeclampsia, preterm delivery, birth weight, and weight gained during pregnancy and the 5-minute Apgar scores adjusted for gestational age (SGA) of the fetus. Conclusion: Low 75 g OGT results are significantly associated with increased risk of neonatal intensive care unit (NICU) admissions.

scholarly journals Outbreak of Bacillus cereus Infections in a Neonatal Intensive Care Unit Traced to Balloons Used in Manual Ventilation

2000 ◽  
Vol 38 (11) ◽  
pp. 4131-4136 ◽  
Author(s):  
Wil C. Van Der Zwet ◽  
Gerard A. Parlevliet ◽  
Paul H. Savelkoul ◽  
Jeroen Stoof ◽  
Annie M. Kaiser ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Bacillus Cereus ◽  
Neonatal Intensive Care ◽  
Case Control Study ◽  
Case Control ◽  
Manual Ventilation ◽  
Prospective Surveillance ◽  
Control Study

In 1998, an outbreak of systemic infections caused byBacillus cereus occurred in the Neonatal Intensive Care Unit of the University Hospital Vrije Universiteit, Amsterdam, The Netherlands. Three neonates developed sepsis with positive blood cultures. One neonate died, and the other two neonates recovered. An environmental survey, a prospective surveillance study of neonates, and a case control study were performed, in combination with molecular typing, in order to identify potential sources and transmission routes of infection. Genotypic fingerprinting by amplified-fragment length polymorphism (AFLP) showed that the three infections were caused by a single clonal type of B. cereus. The same strain was found in trachea aspirate specimens of 35 other neonates. The case control study showed mechanical ventilation with a Sensormedics ventilation machine to be a risk factor for colonization and/or infection (odds ratio, 9.8; 95% confidence interval, 1.1 to 88.2). Prospective surveillance showed that colonization with B. cereusoccurred exclusively in the respiratory tract of mechanically ventilated neonates. The epidemic strain of B. cereus was found on the hands of nursing staff and in balloons used for manual ventilation. Sterilization of these balloons ended the outbreak. We conclude that B. cereus can cause outbreaks of severe opportunistic infection in neonates. Typing by AFLP proved very useful in the identification of the outbreak and in the analysis of strains recovered from the environment to trace the cause of the epidemic.

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