Contaminated Incubators: Source of a Multispecies Enterobacter Outbreak of Neonatal Sepsis

Alonso, Enrique Hernández; Bourgeois-Nicolaos, Nadège; Lepainteur, M.; Derouin, Véronique; Barreault, Simon; Waalkes, Adam; Augusto, Luis; Gera, Stuti; Gleizes, O; Tissières, Pierre; Salipante, Stephen J.; Luca, Danièle De; Doucet‐Populaire, Florence

doi:10.1128/spectrum.00964-22

Cited by 7 publications

(2 citation statements)

References 44 publications

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“…We cannot exclude that these bacteria were present in another site of the incubator that has not been sampled and grow up with the moistening and heat of the incubator. This hypothesis is in agreement with the work of Hernandez-Alonso et al who found that the recovery of Enterobacter from incubators after disinfection was facilitated after the incubator was running on, probably because in this condition temperature and humidity are optimal for bacterial regrowth [28]. Furthermore, the early contamination of incubators can come from caregivers and parents.…”

Section: Discussionsupporting

confidence: 91%

Disinfection of incubators in neonatal intensive care units: impact of steam pulverization on bacterial colonization

Reboux

Chavignon

Tristan

et al. 2023

Antimicrob Resist Infect Control

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Background In neonatal intensive care units (NICUs), neonates requiring medical care after birth, including very vulnerable preterm infants, are housed in incubators. Previous studies have reported that the standard chemical disinfection measures used to disinfect these incubators are insufficient to eradicate contaminating bacteria, leading to a worrying infectious risk for preterm neonates. This study aimed to evaluate the efficacy of a disinfection method based on steam pulverization to eradicate the persistent bacterial contamination in such incubators. Methods In a tertiary NICU, 20 incubators were monitored qualitatively for bacterial contamination at five different sites (the rubber grommet, the left door handles, the temperature adjustment button, the mattress and the scale) using a culture method at three times: before and after steam pulverization then 24 h after turning on and housing a new neonate. Clinical data of neonates housed in each incubator were retrieved from the medical records to identify potential occurrence of late onset sepsis (LOS). Results Just after steam pulverization, only two incubators were free from bacteria. Before disinfection 87% of all the samples were contaminated compared to 61% after disinfection. After 24 h, the proportion of contaminated samples reached 85%. Mattresses and scales were the most frequently contaminated incubator sites with respectively 90% and 80% positive samples after disinfection compared to 100% and 90% before disinfection. Coagulase-negative staphylococci, Enterococcus, Enterobacteria and Bacillus resisted disinfection and were identified on respectively 90%, 20%, 5% and 45% of incubators just after disinfection. Three preterm neonates developed LOS after being housed in a disinfected incubator but the bacterial species involved have not been identified in their incubator after disinfection. In two cases, the bacterium had been isolated from the mattress 24 h after housing the infected patient. Conclusion Steam pulverization is not sufficient to eradicate bacterial contamination of incubators. These results highlight the urgent need for an effective disinfection method, especially for mattresses that are in constant contact with patients. In parallel, new incubator designs and mattress protections must be developed.

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Section: Discussionsupporting

confidence: 91%

Disinfection of incubators in neonatal intensive care units: impact of steam pulverization on bacterial colonization

Reboux

Chavignon

Tristan

et al. 2023

Antimicrob Resist Infect Control

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“…Currently, there are 56 species within the genus Enterobacter, 22 of which are published with accepted names [List of Prokaryotic Names with Standing in Nomenclature (accessed: 7 June 2023); https://lpsn.dsmz.de/genus/ Enterobacter] [47]. Although not all species are pathogenic, some have emerged as important nosocomial pathogens and are generally referred to as the Enterobacter cloacae complex [48][49][50][51]. The Enterobacter T6SS has been investigated in E. cloacae type strain ATCC 13047, which possesses two T6SS clusters (termed T6SS-1 and T6SS-2) utilized for gut colonization, bacterial competition, biofilm formation and epithelial cell adherence [40].…”

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confidence: 99%

Distribution and diversity of type VI secretion system clusters in Enterobacter bugandensis and Enterobacter cloacae

Anderson,

Morrell,

Lopez Campos

et al. 2023

Microbial Genomics

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Gram-negative bacteria use type VI secretion systems (T6SSs) to antagonize neighbouring cells. Although primarily involved in bacterial competition, the T6SS is also implicated in pathogenesis, biofilm formation and ion scavenging. Enterobacter species belong to the ESKAPE pathogens, and while their antibiotic resistance has been well studied, less is known about their pathogenesis. Here, we investigated the distribution and diversity of T6SS components in isolates of two clinically relevant Enterobacter species, E. cloacae and E. bugandensis . T6SS clusters are grouped into four types (T6SSi-T6SSiv), of which type i can be further divided into six subtypes (i1, i2, i3, i4a, i4b, i5). Analysis of a curated dataset of 31 strains demonstrated that most of them encode T6SS clusters belonging to the T6SSi type. All T6SS-positive strains possessed a conserved i3 cluster, and many harboured one or two additional i2 clusters. These clusters were less conserved, and some strains displayed evidence of deletion. We focused on a pathogenic E. bugandensis clinical isolate for comprehensive in silico effector prediction, with comparative analyses across the 31 isolates. Several new effector candidates were identified, including an evolved VgrG with a metallopeptidase domain and a Tse6-like protein. Additional effectors included an anti-eukaryotic catalase (KatN), M23 peptidase, PAAR and VgrG proteins. Our findings highlight the diversity of Enterobacter T6SSs and reveal new putative effectors that may be important for the interaction of these species with neighbouring cells and their environment.

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Interventions implemented to remediate mold identified in Neonatal Intensive Care Unit (NICU) incubators, 2022 to 2023

Kovar,

McPherson,

Ware

et al. 2024

American Journal of Infection Control

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Contaminated Incubators: Source of a Multispecies Enterobacter Outbreak of Neonatal Sepsis

Cited by 7 publications

References 44 publications

Disinfection of incubators in neonatal intensive care units: impact of steam pulverization on bacterial colonization

Disinfection of incubators in neonatal intensive care units: impact of steam pulverization on bacterial colonization

Distribution and diversity of type VI secretion system clusters in Enterobacter bugandensis and Enterobacter cloacae

Interventions implemented to remediate mold identified in Neonatal Intensive Care Unit (NICU) incubators, 2022 to 2023

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