Clinical profile and risk factors associated with Elizabethkingia anophelis infection in neonates born in a tertiary care hospital-a case-control study and outbreak investigation.
J Trop Pediatr
; 70(5)2024 Aug 10.
Article
en En
| MEDLINE
| ID: mdl-39164190
ABSTRACT
The objective of this study was to determine the risk factors associated with Elizabethkingia anophelis infection in neonates admitted to a tertiary care neonatal intensive care unit (NICU). A case-control study was undertaken as part of the outbreak investigation for E. anophelis sepsis in a tertiary care NICU in South India. Thirty-eight neonates with E. anophelis bloodstream infection (BSI) between January 2021 and February 2022 were enrolled as cases, and 38 neonates symptomatic with other BSIs, were selected as controls, and risk factors analysed. The 38 cases were relatively stable neonates, likely to be admitted to level 1 and level 2 NICU, unlike the controls, who were sicker and required level 3 NICU care. Only a third of neonates with Elizabethkingia sepsis had traditional risk factors like central lines, need for respiratory support or perinatal risk factors. Multiple logistic regression analysis revealed that neonates with E. anophelis infection were more likely to be stable and on only enteral feeds, cared in level 1 or 2 of the NICU. This observation, combined with isolation of Elizabethkingia meningosepticum from breast pumps earlier, led us to autoclave the feeding vessels and milk containers along with provision of hot water for cleaning breast pumps, and adoption of general infection control measures, after which incident cases declined. Sanger sequencing of 10 representative isolates obtained from the neonates showed 100% sequence identity to E. anophelis. Infection due to E. anophelis affects relatively stable neonates without traditional risk factors for sepsis. Adherence to asepsis routines and housekeeping protocols helps to prevent the spread of infection.
Elizabethkingia anophelis is an emerging pathogen causing infection in neonates. In the present casecontrol study, we found that E. anophelis was more likely to infect otherwise healthy neonates, on enteral nutrition, without the traditional risk factors for sepsis. Mortality was 23.7% (9/38). About 55.3% (21/38) had meningitis and 23.8% (9/38) had hydrocephalus. Additionally, 76% isolates were multi-drug resistant, with the isolates showing highest susceptibility to minocycline (100%) and levofloxacin (97.8%). Source identification was not possible even after multiple rounds of extensive environmental testing, but it is possibly related to contamination of water and/or milk sources. Interventions addressing the same led to a dramatic decline in the infection rates, though occasional infection without clustering continues to occur. Sanger sequencing of 10 representative isolates confirmed sequence identity to E. anophelis.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Unidades de Cuidado Intensivo Neonatal
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Brotes de Enfermedades
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Flavobacteriaceae
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Infecciones por Flavobacteriaceae
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Centros de Atención Terciaria
Límite:
Female
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Humans
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Male
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Newborn
País/Región como asunto:
Asia
Idioma:
En
Revista:
J Trop Pediatr
Año:
2024
Tipo del documento:
Article
País de afiliación:
India
Pais de publicación:
Reino Unido