Affiliation:
1. Departments of Medical Microbiology and Infection Control1 and
2. Pediatrics,2 University Hospital Vrije Universiteit, Amsterdam, The Netherlands
Abstract
ABSTRACT
In 1998, an outbreak of systemic infections caused by
Bacillus 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. cereus
occurred 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.
Publisher
American Society for Microbiology
Cited by
78 articles.
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