- Email: [email protected]
PP-142. Acinetobacter baumannii outbreak associated with breast-milk pump in a neonatal intensive care unit
S74
Abstracts
caryotype was normal (46, XX). The neonate required immediate surgical intervention due to respiratory compromise that revealed an extended form of right congenital diaphragmatic eventration (CDE). Fifty-five ml of pleural fluid was drained from the right hemithorax. A thin diaphragm was covering the liver and the intestine that was herniated in the right hemithorax. Histological examination of diaphragmatic tissue revealed lack of muscle cells with loose connective tissue, rich vascularisation and lymphocytic infiltration. By the means of PCR we identified the genome of Parvovirus B19 in the pleural fluid. Both pleural fluid and blood cultures were negative. Positive maternal serologic test for previous Parvo B19 infection confirmed our hypothesis for intrauterine infection.
Conclusions
Conclusion
PP-142. Acinetobacter baumannii outbreak associated with breastmilk pump in a neonatal intensive care unit
Besides cardiac malformations, ascites and hydrothorax, this neonate presented CDE; to our knowledge, this is the first case report associating CDE and intrauterine Parvo B19 infection. doi:10.1016/j.earlhumdev.2010.09.194
PP-141. Neonatal candida infections and antifungal susceptibility testing
All of the isolates in this study group were susceptible to AMB. Fluconazole resistance was found as 5.5%. We found that the clinical treatment failure was higher than the resistance rate. Although antifungal susceptibility tests are helpful in guiding the therapy, in vivo and in vitro difference should be taken into account in susceptible cases with treatment failure. doi:10.1016/j.earlhumdev.2010.09.195
Bilin Cetinkaya Cakmaka, Defne Engura, Mete Eyigorb, Murat Tellib, Melike Guzunlerc, Munevver Kaynak Turkmena a Adnan Menderes University, Faculty of Medicine, Neonatology Department, Turkey b Adnan Menderes University, Faculty of Medicine, Microbiology Department, Turkey c Adnan Menderes University, Faculty of Medicine, Department of Pediatrics, Turkey Aim
Emel Altuncua, Hulya Bilgena, Nilgun Cerikcioglub, Arzu Ilkib, Nurver Ulgerb, Mustafa Bakırc, Ipek Akmana, Eren Ozeka a Marmara University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Turkey b Marmara University Faculty of Medicine, Department of Microbiology, Division of Pediatric Infectious Diseases, Turkey c Marmara University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Turkey Aim In this study, species of the candida isolates from neonates with candida infections, their antifungal susceptibilities and the effectiveness of the therapy were evaluated. Materials and methods All species of candida isolates from sterile body fluids of 54 neonates and their antifungal susceptibilities were evaluated retrospectively. Demographic characteristics, risk factors, infection foci, candida species causing infection and its in vitro susceptibilities for fluconazole (FCZ) and amphotericin B (AMB) and treatment response were analyzed. The antifungal susceptibility testing of isolates for AMB and FCZ was performed by microdilution technique. Results The median birth weight and gestational age of the study group were 1735 (660–3990) g and 33 (24–40) weeks, respectively. Among the patients, 35% was term, 65% was preterm. Candida spp. was isolated mostly from blood and it was followed by urine, cerebrospinal and peritoneal fluid. The isolated species were C. albicans as being the most common isolate followed by C. parapsilosis, C. tropicalis, C. kefyr, C. lusitaniae, and C. pelluculosa. Overall the FCZ resistance rate was 5.5%. No resistance was observed for AMB. Initial treatment was FCZ for 78% and AMB for 22% of the newborns. The treatment was switched to AMB in 15 (28%) cases because of no clinical or laboratory response to FCZ although only three of these babies showed resistance to fluconazole. C. albicans was isolated (66%) mainly and followed by non-albicans species (33%) among cases having no clinical/laboratory response.
Contamination of the clinical environment has been implicated during Acinetobacter outbreaks. Acinetobacter spp. can survive on dry surfaces for long periods of time. This leads to environmental contamination, and makes the outbreak difficult to overcome. Various environmental sources have been reported in the transmission of outbreak strains, including room humidifiers, air conditioning equipment, mattresses, pillows, curtains, hygroscopic bandages and ventilation equipment. Breast-milk pumps can also serve as a reservoir. We describe an outbreak of Acinetobacter baumannii associated with breast-milk pump and the results of the epidemiologic investigations in our clinic. Materials and methods In July 2009, A. baumannii was isolated from endotracheal tube cultures of two babies in our unit. 45 environmental cultures, air samples and 30 hand cultures from health personnel were obtained for source investigation. Between July and September 2009, six additional cases were seen. Bacterial identification and antibiogram were obtained via automatized system (Phoenix, BD). Clonal relation was investigated by pulse field gel electrophoresis (PFGE) method. Results The main common point of the cases was feeding with expressed breast milk. A. baumannii was isolated from breast-milk pump and expressed breast milk of 7 cases. PFGE typing revealed the same strain. One of the cases died due to severe congenital anomalies on the third day of his life. Terminal disinfection was carried out after closure of the unit. Adequate sterilization of the pump was instituted. New patients were accepted when repeated environmental cultures were shown to be negative. Conclusions Retrograde contamination of freshly collected milk may occur from previously contaminated components of the pump, despite use of a sterile collecting bottle. Proper sterilization of all removable components is critical when a single breast pump is used by more
Abstracts
than one person. This is the first case of A. baumannii outbreak associated with breast-milk pump in a NICU. doi:10.1016/j.earlhumdev.2010.09.196
PP-143. Impact of maternal and neonatal risk factors on neonatal Escherichia coli colonization Rasa Tamelienea, Egle Barcaiteb, Ruta Jolanta Nadisauskieneb, Astra Vitkauskienec, Daiva Jomantienec, Egle Markunienea, Jurate Buinauskienea, Dalia Stonienea a Department of Neonatology, Kaunas University of Medicine, Lithuania b Department of Obstetrics and Gynaecology, Kaunas University of Medicine, Lithuania c Department of Microbiology, Kaunas University of Medicine, Lithuania Aim The organisms that cause early-onset sepsis include Streptococcus agalactiae and Escherichia coli. The source of these pathogens in neonatal infections is the maternal genital tract. Still no special studies regarding the frequency of E. coli colonization, as well as mechanisms of its transmission, among pregnant women and neonates, are available up till now. Materials and methods A prospective cross-sectional study was carried out at the Departments of Obstetrics & Gynecology and Neonatology Kaunas University of Medicine Hospital in 2006–2007. Data of 970 women and 827 newborns were analyzed. A lower vaginal and rectal swab was obtained from each woman at 35–37 weeks of gestation or at delivery. Cultures of neonates were sampled from the ear canal and throat within 5–15 min of their lives. Women were asked to complete a questionnaire about the sociodemographic status, lifestyle, personal hygiene and sexual life habits, former pregnancies, the course of deliveries and the previous illness. E. coli were identified on the basis of their biochemical properties. Susceptibility to antibiotics was established by disk diffusion method. Results E. coli colonization was found in 193 women (19.9%) and 119 neonates (14.4%). Of the E. coli cultures grown 25.9% and 22.7% were resistant to ampicillin in mothers and neonates respectively. The E. coli vertical transmission frequency amounted to 21.4%. Multifactor logistic regression revealed the following risk factors associated with the neonatal E. coli colonization: anal sexual intercourse OR 3.91 (95% CI 1.87–8.19), one sexual partner OR 2.01 (95% CI 1.87–8.19), maternal colonization E. coli OR 1.81 (95% CI 1.12–2.93), maternal BMI ≤27 OR 1.77 (95% CI 1.15–2.73), and non-university maternal education OR 1.70 (95% CI 1.06–2.74).
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Albina Bulaukiened, Rita Tvarijonavicienee, Banga Vaitkevicienef, Jolanta Gineikieneg, Audrius Maciuleviciusa a Kaunas University of Medicine, Lithuania b Vilnius University, Faculty of Medicine, Lithuania c Children's Hospital of Vilnius University, Lithuania d Hospital of Klaipeda University, Lithuania e Hospital of Panevėžys, Lithuania f Hospital of Šiauliai, Lithuania g Kaunas 2-Nd Clinical Hospital, Lithuania Aim Bacterial sepsis is a major cause of morbidity and mortality in neonates. Early-onset neonatal infection (EONI) is a major contributor to these sequelae. There are no data about EONI rate in Lithuania. The aim of our study was to analyze the etiology of EONI, the forms of its manifestation, and the tactic of empirical antibacterial treatment. Materials and methods A prospective cohort study of 58,417 neonates born at the eight second and tertiary-care hospitals in 2006–2007 was performed. Cases of EONI were included into the study: unverified early–onset infection, early–onset sepsis (EOS), meningitis, osteomyelitis, necrotizing enterocolitis, urinary tract infection and pneumonia. Results 1358 cases of EONI have been diagnosed: unverified EONI — 1044 (76.9%), pneumonia — 150 (11.1%), early-onset sepsis (EOS) — 122 (8.9%), meningitis 20 (1.5%), necrotizing enterocolitis 17 (1.2%), and urinary tract infection 5 (0.4%). EONS was caused by Streptococci in 53.3% (78.7% of them S. agalactiae), Staphylococi 13.7%, L. monocytogenes 10.2%, and E. coli 9.1%. 237 (22.7%) newborns were treated without blood culture. Full-term newborns were more often ill with sepsis caused by S. agalactiae than preterm. EONI most often was treated empirically with penicillin and gentamicin (99.43%), sometimes with cefotaxim (13.8%), ampicillin (1.4%), and cefuroxim (1.4%). But even 45 newborns (3.4%) were treated with amikacin, ceftazidim, meronem, and vancomycin. Conclusions According to the data of the study the morbidity of neonatal EOS in Lithuania is 1.5/1000 live born. The morbidity of EOS caused by BGS is 0.63/1000, E. coli — 0.13/1000, and L. monocytogenes — 0.15/1000 live borns. Almost one third of newborns were treated with antibiotics without having blood culture, so it is possible to state that the defined sepsis frequency is only approximate rather than exact. There must be single tactics of empirical treatment of EONI in Lithuania.
doi:10.1016/j.earlhumdev.2010.09.198 Conclusions We consider that changing of sexual habits, improvement of hygiene behaviours and higher maternal education could help to facilitate the neonatal E. coli colonization.
PP-145. Newborn hospitalizations associated with pandemic influenza A H1N1
doi:10.1016/j.earlhumdev.2010.09.197
Joana Jardim, Albina Silva, Carla Sa, Eduarda Abreu, Matos Marques, Bernardete Fernandes, Almerinda Pereira Neonatal Intensive Care Unit, Hospital De Braga, Portugal
PP-144. Early-onset neonatal infection in Lithuania
Aim
Rasa Tamelienea, Dalia Stonienea, Egle Markunienea, Nijole Drazdieneb, Nijole Vezbergienec, Vladimiras Chijenasa,
Infection with influenza A pandemic 2009 (H1N1) has been reported worldwide following initial identification of the virus in
Abstracts
caryotype was normal (46, XX). The neonate required immediate surgical intervention due to respiratory compromise that revealed an extended form of right congenital diaphragmatic eventration (CDE). Fifty-five ml of pleural fluid was drained from the right hemithorax. A thin diaphragm was covering the liver and the intestine that was herniated in the right hemithorax. Histological examination of diaphragmatic tissue revealed lack of muscle cells with loose connective tissue, rich vascularisation and lymphocytic infiltration. By the means of PCR we identified the genome of Parvovirus B19 in the pleural fluid. Both pleural fluid and blood cultures were negative. Positive maternal serologic test for previous Parvo B19 infection confirmed our hypothesis for intrauterine infection.
Conclusions
Conclusion
PP-142. Acinetobacter baumannii outbreak associated with breastmilk pump in a neonatal intensive care unit
Besides cardiac malformations, ascites and hydrothorax, this neonate presented CDE; to our knowledge, this is the first case report associating CDE and intrauterine Parvo B19 infection. doi:10.1016/j.earlhumdev.2010.09.194
PP-141. Neonatal candida infections and antifungal susceptibility testing
All of the isolates in this study group were susceptible to AMB. Fluconazole resistance was found as 5.5%. We found that the clinical treatment failure was higher than the resistance rate. Although antifungal susceptibility tests are helpful in guiding the therapy, in vivo and in vitro difference should be taken into account in susceptible cases with treatment failure. doi:10.1016/j.earlhumdev.2010.09.195
Bilin Cetinkaya Cakmaka, Defne Engura, Mete Eyigorb, Murat Tellib, Melike Guzunlerc, Munevver Kaynak Turkmena a Adnan Menderes University, Faculty of Medicine, Neonatology Department, Turkey b Adnan Menderes University, Faculty of Medicine, Microbiology Department, Turkey c Adnan Menderes University, Faculty of Medicine, Department of Pediatrics, Turkey Aim
Emel Altuncua, Hulya Bilgena, Nilgun Cerikcioglub, Arzu Ilkib, Nurver Ulgerb, Mustafa Bakırc, Ipek Akmana, Eren Ozeka a Marmara University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Turkey b Marmara University Faculty of Medicine, Department of Microbiology, Division of Pediatric Infectious Diseases, Turkey c Marmara University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Turkey Aim In this study, species of the candida isolates from neonates with candida infections, their antifungal susceptibilities and the effectiveness of the therapy were evaluated. Materials and methods All species of candida isolates from sterile body fluids of 54 neonates and their antifungal susceptibilities were evaluated retrospectively. Demographic characteristics, risk factors, infection foci, candida species causing infection and its in vitro susceptibilities for fluconazole (FCZ) and amphotericin B (AMB) and treatment response were analyzed. The antifungal susceptibility testing of isolates for AMB and FCZ was performed by microdilution technique. Results The median birth weight and gestational age of the study group were 1735 (660–3990) g and 33 (24–40) weeks, respectively. Among the patients, 35% was term, 65% was preterm. Candida spp. was isolated mostly from blood and it was followed by urine, cerebrospinal and peritoneal fluid. The isolated species were C. albicans as being the most common isolate followed by C. parapsilosis, C. tropicalis, C. kefyr, C. lusitaniae, and C. pelluculosa. Overall the FCZ resistance rate was 5.5%. No resistance was observed for AMB. Initial treatment was FCZ for 78% and AMB for 22% of the newborns. The treatment was switched to AMB in 15 (28%) cases because of no clinical or laboratory response to FCZ although only three of these babies showed resistance to fluconazole. C. albicans was isolated (66%) mainly and followed by non-albicans species (33%) among cases having no clinical/laboratory response.
Contamination of the clinical environment has been implicated during Acinetobacter outbreaks. Acinetobacter spp. can survive on dry surfaces for long periods of time. This leads to environmental contamination, and makes the outbreak difficult to overcome. Various environmental sources have been reported in the transmission of outbreak strains, including room humidifiers, air conditioning equipment, mattresses, pillows, curtains, hygroscopic bandages and ventilation equipment. Breast-milk pumps can also serve as a reservoir. We describe an outbreak of Acinetobacter baumannii associated with breast-milk pump and the results of the epidemiologic investigations in our clinic. Materials and methods In July 2009, A. baumannii was isolated from endotracheal tube cultures of two babies in our unit. 45 environmental cultures, air samples and 30 hand cultures from health personnel were obtained for source investigation. Between July and September 2009, six additional cases were seen. Bacterial identification and antibiogram were obtained via automatized system (Phoenix, BD). Clonal relation was investigated by pulse field gel electrophoresis (PFGE) method. Results The main common point of the cases was feeding with expressed breast milk. A. baumannii was isolated from breast-milk pump and expressed breast milk of 7 cases. PFGE typing revealed the same strain. One of the cases died due to severe congenital anomalies on the third day of his life. Terminal disinfection was carried out after closure of the unit. Adequate sterilization of the pump was instituted. New patients were accepted when repeated environmental cultures were shown to be negative. Conclusions Retrograde contamination of freshly collected milk may occur from previously contaminated components of the pump, despite use of a sterile collecting bottle. Proper sterilization of all removable components is critical when a single breast pump is used by more
Abstracts
than one person. This is the first case of A. baumannii outbreak associated with breast-milk pump in a NICU. doi:10.1016/j.earlhumdev.2010.09.196
PP-143. Impact of maternal and neonatal risk factors on neonatal Escherichia coli colonization Rasa Tamelienea, Egle Barcaiteb, Ruta Jolanta Nadisauskieneb, Astra Vitkauskienec, Daiva Jomantienec, Egle Markunienea, Jurate Buinauskienea, Dalia Stonienea a Department of Neonatology, Kaunas University of Medicine, Lithuania b Department of Obstetrics and Gynaecology, Kaunas University of Medicine, Lithuania c Department of Microbiology, Kaunas University of Medicine, Lithuania Aim The organisms that cause early-onset sepsis include Streptococcus agalactiae and Escherichia coli. The source of these pathogens in neonatal infections is the maternal genital tract. Still no special studies regarding the frequency of E. coli colonization, as well as mechanisms of its transmission, among pregnant women and neonates, are available up till now. Materials and methods A prospective cross-sectional study was carried out at the Departments of Obstetrics & Gynecology and Neonatology Kaunas University of Medicine Hospital in 2006–2007. Data of 970 women and 827 newborns were analyzed. A lower vaginal and rectal swab was obtained from each woman at 35–37 weeks of gestation or at delivery. Cultures of neonates were sampled from the ear canal and throat within 5–15 min of their lives. Women were asked to complete a questionnaire about the sociodemographic status, lifestyle, personal hygiene and sexual life habits, former pregnancies, the course of deliveries and the previous illness. E. coli were identified on the basis of their biochemical properties. Susceptibility to antibiotics was established by disk diffusion method. Results E. coli colonization was found in 193 women (19.9%) and 119 neonates (14.4%). Of the E. coli cultures grown 25.9% and 22.7% were resistant to ampicillin in mothers and neonates respectively. The E. coli vertical transmission frequency amounted to 21.4%. Multifactor logistic regression revealed the following risk factors associated with the neonatal E. coli colonization: anal sexual intercourse OR 3.91 (95% CI 1.87–8.19), one sexual partner OR 2.01 (95% CI 1.87–8.19), maternal colonization E. coli OR 1.81 (95% CI 1.12–2.93), maternal BMI ≤27 OR 1.77 (95% CI 1.15–2.73), and non-university maternal education OR 1.70 (95% CI 1.06–2.74).
S75
Albina Bulaukiened, Rita Tvarijonavicienee, Banga Vaitkevicienef, Jolanta Gineikieneg, Audrius Maciuleviciusa a Kaunas University of Medicine, Lithuania b Vilnius University, Faculty of Medicine, Lithuania c Children's Hospital of Vilnius University, Lithuania d Hospital of Klaipeda University, Lithuania e Hospital of Panevėžys, Lithuania f Hospital of Šiauliai, Lithuania g Kaunas 2-Nd Clinical Hospital, Lithuania Aim Bacterial sepsis is a major cause of morbidity and mortality in neonates. Early-onset neonatal infection (EONI) is a major contributor to these sequelae. There are no data about EONI rate in Lithuania. The aim of our study was to analyze the etiology of EONI, the forms of its manifestation, and the tactic of empirical antibacterial treatment. Materials and methods A prospective cohort study of 58,417 neonates born at the eight second and tertiary-care hospitals in 2006–2007 was performed. Cases of EONI were included into the study: unverified early–onset infection, early–onset sepsis (EOS), meningitis, osteomyelitis, necrotizing enterocolitis, urinary tract infection and pneumonia. Results 1358 cases of EONI have been diagnosed: unverified EONI — 1044 (76.9%), pneumonia — 150 (11.1%), early-onset sepsis (EOS) — 122 (8.9%), meningitis 20 (1.5%), necrotizing enterocolitis 17 (1.2%), and urinary tract infection 5 (0.4%). EONS was caused by Streptococci in 53.3% (78.7% of them S. agalactiae), Staphylococi 13.7%, L. monocytogenes 10.2%, and E. coli 9.1%. 237 (22.7%) newborns were treated without blood culture. Full-term newborns were more often ill with sepsis caused by S. agalactiae than preterm. EONI most often was treated empirically with penicillin and gentamicin (99.43%), sometimes with cefotaxim (13.8%), ampicillin (1.4%), and cefuroxim (1.4%). But even 45 newborns (3.4%) were treated with amikacin, ceftazidim, meronem, and vancomycin. Conclusions According to the data of the study the morbidity of neonatal EOS in Lithuania is 1.5/1000 live born. The morbidity of EOS caused by BGS is 0.63/1000, E. coli — 0.13/1000, and L. monocytogenes — 0.15/1000 live borns. Almost one third of newborns were treated with antibiotics without having blood culture, so it is possible to state that the defined sepsis frequency is only approximate rather than exact. There must be single tactics of empirical treatment of EONI in Lithuania.
doi:10.1016/j.earlhumdev.2010.09.198 Conclusions We consider that changing of sexual habits, improvement of hygiene behaviours and higher maternal education could help to facilitate the neonatal E. coli colonization.
PP-145. Newborn hospitalizations associated with pandemic influenza A H1N1
doi:10.1016/j.earlhumdev.2010.09.197
Joana Jardim, Albina Silva, Carla Sa, Eduarda Abreu, Matos Marques, Bernardete Fernandes, Almerinda Pereira Neonatal Intensive Care Unit, Hospital De Braga, Portugal
PP-144. Early-onset neonatal infection in Lithuania
Aim
Rasa Tamelienea, Dalia Stonienea, Egle Markunienea, Nijole Drazdieneb, Nijole Vezbergienec, Vladimiras Chijenasa,
Infection with influenza A pandemic 2009 (H1N1) has been reported worldwide following initial identification of the virus in