Outbreak of colonizations by extended-spectrum β-lactamase-producing Escherichia coli sequence type 131 in a neonatal intensive care unit, Italy

Abstract Background Extended spectrum β-lactamases (ESBLs) often associated with resistance to aminoglycosides and fluoroquinolones have recently emerged in community-associated Escherichia coli. The worldwide clonal dissemination of E. coli sequence type (ST)131 is playing a prominent role. We describe an outbreak of colonizations by ESBL-producing E. coli (ESBL-E. coli) in the neonatal intensive care unit (NICU) of the University Hospital, Palermo, Italy. Methods An epidemiological investigation was conducted with the support of molecular typing. All children admitted to the NICU and colonized by ESBL-E. coli between January and June 2012, were included in the study. Cases were defined as…

Neonatal sepsis caused by Ralstonia pickettii

e describe the clinical case of apremature newborn, born at 26weeks by cesarean delivery, followed inthe neonatal intensive care unit. Themother was diabetic with adequate con-trol during pregnancy.Neonatal weight was 930 g;APGAR score 3 at 1 minute and 8 at 5minutes. She received forced ventilationby endotracheal tube and parenteralnutrition by a central venous catheter.She was treated with ampicillin for thefirst 20 days of life. At 25 days, apneaand bradychardia episodes occurredwith a progressive increment in sever-ity and frequency. Leukocytes, C-re-active protein, cerebral echography,and echocardiogram were normal.Oralfeeding was transiently stopped and rani-tidine treatment was starte…

DETECTION OF A NEW VIM TYPE METALLO-BETA-LACTAMASE (VIM 11) IN A PSEUDOMONAS AERUGINOSA CLINICAL ISOLATE FROM ITALY

A novel VIM‐type metallo‐beta‐lactamase (VIM‐14) in a Pseudomonas aeruginosa clinical isolate from a neonatal intensive care unit

AbstractA Pseudomonas aeruginosa highly resistant to carbapenems was isolated in a neonatal intensive care unit in Palermo, Italy. The strain was found to carry a novel VIM‐type enzyme, classified as VIM‐14. The novel enzyme differs from VIM‐4 in a G31S mutation. VIM‐14 was harboured in a class 1 integron with a new organization. The integron carried the genes aac7, blaVIM‐14, blaOXA‐20 and aac4 in that order.

Surveillance of enteric virus infections in a neonatal intensive care unit.

Objective. To investigate the epidemiology of neonatal viral gastroenteritis compared to the circulation of enteric viruses in children, 109 newborns in the NICU of Mother and Child Department and 214 children with enteritis admitted to the “G. Di Cristina” Children’s Hospital in Palermo were monitored for Rotavirus, Adenovirus, Astrovirus and Norovirus infections. Methods. Stool samples were examined by EIA to detect viral antigens. Rotavirus strains were subjected to P- and G-typing. Results. A Norovirus strain was detected in one neonatal stool specimen whereas an astrovirus strain was dectected in two neonatal specimens. No Rotavirus or Adenovirus infection was identified among the newb…

Surveillance of multidrug-resistant gram-negative bacilli in a neonatal intensive care unit: prominent role of cross transmission

Background Multidrug-resistant gram-negative bacilli (MDRGN) are an important cause of nosocomial infections in neonatal intensive care units (NICUs). We conducted a 1-year prospective surveillance study in an NICU to assess the epidemiology of MDRGN among newborns and the relative importance of acquisition routes. Methods Neonates admitted at the NICU of the Dipartimento Materno-Infantile, University Hospital, Palermo, Italy, from January 7, 2003, to January 6, 2004, were included in the study. Colonization of patients with MDRGN was assessed by cultures of rectal swabs sampled twice a week. Pulsed-field gel electrophoresis was used to determine relatedness among MDRGN isolates. Extended-s…

Circolazione di MRSA in età pediatrica in ambiente ospedaliero e in comunità

Introduzione. Negli ultimi anni si è assistito ad un generale incremento e ad una sempre più estesa diffusione, sia in ambito ospedaliero che comunitario, di microrganismi multiresistenti. In assenza ed in attesa di trattamenti farmacologici efficaci maggiore attenzione deve essere impiegata alla realizzazione di strategie di sorveglianza mirate. Il primo isolamento di un ceppo di Staphylococcus aureus meticillinoresistente (MRSA) risale al 1961 e fu seguito da una repentina diffusione negli ospedali di tutto il mondo. Ad oggi MRSA è riconosciuto come uno dei principali agenti responsabili delle infezioni nosocomiali e le percentuali di isolamento variano da Paese in Paese in maniera notevo…

CANDIDA SEPTIC THROMBOSIS OF THE LEFT ATRIUM IN TWINS: REPORT OF TWO CASES

Background: Preterms are often exposed to nosocomial infections in NICU. Candida infections are particularly common and can result in progressive organization of intracardiac thrombosis, usually in the right atrium. Design and population: GB (24.4 wg, 460 g, bigeminal pregnancy): he was affected by RDS, PDA, jaundice, anaemia and had been submitted to TPN with CVC, also because of anus imperforate. On the 50th day, haemoculture resulted positive for Candida parapsilosis and, by echocardiography, hyperecogen peduncolate formation in the appendix of left auricola. Despite antifungal therapy, exitus occurred. CM (32.4 wg, 1390 g, bigeminal pregnancy): on 2nd day, she was operated for “apple-pe…

Nosocomial colonization due to imipenem-resistant Pseudomonas aeruginosa epidemiologically linked to breast milk feeding in a neonatal intensive care unit.

Aim: We describe a one-year investigation of colonization by imipenemresistant, metallo-β-lactamase (MBL) producing Pseudomonas aeruginosa in a neonatal intensive care unit (NICU) of the University Hospital of Palermo, Italy. Methods: A prospective epidemiological investigation was conducted in the period 2003 January to 2004 January. Rectal swabs were collected twice a week from all neonates throughout their NICU stay. MBL production by imipenem-resistant strains of P aeruginosa was detected by phenotypic and molecular methods. Pulsed field gel electrophoresis (PFGE) was carried out on all isolates of P aeruginosa. The association between risk factors and colonization by imipenem-resistant…

Arteria ombelicale unica (AOU): un marker di anomalie congenite

Epidemic spread of ST1-MRSA-IVa in a neonatal intensive care unit, Italy

Abstract Background Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has recently emerged as an important pathogen in neonatal intensive care units (NICUs). The purposes of this study were to characterize methicillin-resistant isolates from an outbreak in a NICU, to examine the genetic traits and clonality of CA-MRSA, and to review the characteristics and outcomes of the neonatal cases and investigate the routes of entry and transmission of the MRSA outbreak strain in the NICU under study. Methods The study NICU practiced an active surveillance program for multidrug-resistant organisms, including weekly cultures for detection of MRSA from nasal swabs among all the …

Prevention of nosocomial infections and surveillance of emerging resistances in NICU

Neonates hospitalized in NICU are at risk for healthcare associated infections because of their poor immune defenses, related to gestational age, colonization of mucous membranes and skin with nosocomial microorganisms, exposure to antibiotics, invasive procedures and frequent contacts with healthcare workers (HCWs). Healthcare associated infections are the major source of morbidity and mortality in NICU in the developed world. Most infections are caused by Gram-positive organisms, fulminant sepsis are often associated to Gram-negative organisms, fungal sepsis occurs frequently in ELBW infants. Hand hygiene is the most important preventive procedure, nevertheless hand hygiene compliance amo…

Colonizzazione da Staphylococcus Aureus Meticillino-Resistente (MRSA) in epoca di vita neonatale nell’U.O. Neonatologia e TIN dell’AOUP “P.Giaccone” di Palermo nel periodo 2009 - 2015

Colonizzazione, MRSA, UTIN

MRSA infection in the neonatal intensive care unit

Methicillin-resistant Staphylococcus aureus (MRSA) is well known as one of the most frequent etiological agents of healthcare-associated infections. The epidemiology of MRSA is evolving with emergence of community-associated MRSA, the clonal spread of some successful clones, their spillover into healthcare settings and acquisition of antibacterial drug resistances. Neonatal intensive care unit (NICU) patients are at an especially high risk of acquiring colonization and infection by MRSA. Epidemiology of MRSA in NICU can be very complex because outbreaks can overlap endemic circulation and make it difficult to trace transmission routes. Moreover, increasing prevalence of community-associated…