Journal Article

Controllo di una epidemia da Enterobacter cloacae ESBL produttore in neonatologia

Brambilla, Paola, Zoncada, Alessia, Storti, Samuele, Bianca Giuranna Minerva, Reitano, Francesco, Pan, Angelo, Rossi, Margherita, Cimardi, Leonardo, Segalini, Emilio, Buggè, Concetta, Lupi, Matteo Giovanni, Frittoli, Marta Claudia, Fiorentini, Michela, Scoditti, Francesco, Maghini, Giuseppina, Drera, Bruno, Maria Lidia Raffaella Sinatra, Ferraresi, Alice, Mancini, Michela, Missorini, Silvia

2025

Overview

Background. Enterobacter cloacae complex producing extended-spectrum beta-lactamase - ESBL (ECCOE) is a group of gram-negative pathogens responsible for nosocomial outbreaks in vulnerable patients, among whom neonatal patients represent one of the highest risk groups. Methods. We present data from an ECCOE outbreak identified at the Cremona hospital in January 2024, when a case of ECCOE bacteremia was diagnosed in patient admitted to the Neonatology ward. Following the identification of the index case, an infection prevention and control (IPC) program was implemented, based on: isolation of all positive patients with contact precautions, weekly screening of all hospitalized patients, environmental sampling, a program to improve adherence to hand hygiene, enhanced disinfection procedures, and regular data feedback to the ward staff. Results. The retrospective analysis identified a second infection in January 2024. In 2023, no clinical cases were identified and only one positivity for ECCOE emerged from 301 microbiological screening swabs (0.3%). The prospective analysis did not reveal other infections in the following 11 months. Patient surveillance through swabs showed a baseline prevalence of ECCOE of 15.4% in January, which rose to 30.8% in February, significantly decreased in March, then increased again to 38.5% in June and finally dropped to zero in August. The environmental sampling highlighted only one positivity out of 79 samples (1.3% of the samples). The consumption of alcohol hand rub solution, very low at the start of the outbreak (26 L/1,000 patient days - PD), increased to 113 L/1,000 PD, and then decreased by 70% after the outbreak ended. Conclusions. A rapid and complex IPC intervention focusing on improving hand hygiene can help control an ECCOE outbreak in neonatology. However, maintaining adequate adherence to hand hygiene over time remains very challenging.

• Publisher: Pensiero Scientifico Editore
• Subject: Surfactants