Epidemic gram-negative bacteremia in a neonatal intensive care unit in Guatemala

• Published in: American journal of infection control Vol. 22; no. 3; pp. 163 - 171
• Main Authors: Pegues, David A., Arathoon, Eduardo G., Samayoa, Blanca, Del Valle, Gerardo T., Anderson, Roger L., Riddle, Conradine F., O'Hara, Caroline M., Miller, J.Michael, Hill, Bertha C., Highsmith, Anita K., Jarvis, William R.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.06.1994
• Subjects: Bacteremia - epidemiology; Bacteremia - transmission; Cohort Studies; Cross Infection - epidemiology; Cross Infection - transmission; Delivery, Obstetric - methods; Disease Outbreaks; Female; Gram-Negative Bacteria - isolation & purification; Gram-Negative Bacterial Infections - epidemiology; Gram-Negative Bacterial Infections - transmission; Guatemala - epidemiology; Hand Disinfection; Humans; Infant Care; Infant, Newborn; Intensive Care Units, Neonatal; Male; Personnel, Hospital; Population; Pregnancy; Risk Factors; Water Microbiology; Guatemala; Americas; Central America; Hemic System; Public Health; Bacterial And Fungal Diseases; Biology; Infections; North America; Natural Resources; Latin America; Clinical Research; Guatemala; Research Report; Physiology; Laboratory Examinations And Diagnoses; Health; Risk Factors; Cohort Analysis; Examinations And Diagnoses; Diseases; Treatment; Hematological Effects; Developing Countries; Water Supply; Hygiene
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/0196-6553(94)90005-1

Background: Nosocomial bloodstream infection is an important cause of morbidity and mortality among neonates. From September 1 through December 5, 1990 (epidemic period), gram-negative bacteremia developed in 26 neonates after their admission to the neonatal intensive care unit (NICU) of Hospital General, a 1000-bed public teaching hospital in Guatemala with a 16-bed NICU. Twenty-three of the 26 patients (88%) died. Methods: To determine risk factors for and modes of transmission of gram-negative bacteremia in the NICU, we conducted a cohort study of NICU patients who had at least one blood culture drawn at least 24 hours after admission to the NICU and performed a microbiologic investigation in the NICU. Results: The rate of gram-negative bacteremia was significantly higher among patients born at Hospital General, delivered by cesarian section, and exposed to selected intravenous medications and invasive procedures in the NICU during the 3 days before the referent blood culture was obtained. During the epidemic period, the hospital's chlorinated well-water system malfunctioned; chlorine levels were undetectable and tap water samples contained elevated microbial levels, including total and fecal coliform bacteria. Serratia marcescens was identified in 81% of case-patient blood cultures ( 13 16 ) available for testing and from 57% of NICU personnel handwashings ( 4 7 ). Most S. marcescens blood isolates were serotype 03: H 12 (46%) or 014: H12 (31%) and were resistant to ampicillin (100%) and gentamicin (77%), the antimicrobials used routinely in the NICU. Conclusions: We hypothesize that gram-negative bacteremia occurred after invasive procedures were performed on neonates whose skin became colonized through bathing or from hands of NICU personnel.