Nosocomial outbreak of acute gastroenteritis in a neonatal intensive care unit in tunisia caused by multiply drug resistantSalmonella wien producing SHV-2 beta-lactamase

Abstract

In a Tunisian hospital 27 babies, including 12 who were premature, in a single intensive care unit suffered acute gastroenteritis in the period from January to May 1988. The mean age at the onset of gastroenteritis was 8.4 days; nine babies died. Salmonella wien was isolated from stools (all babies) and blood (4 babies). It was also isolated from the stools of one nurse and from a mattress. Twelve of the babies had received cefotaxime, which was successfully replaced by oral colimycin. The outbreak was stopped by the implementation of infection control measures. All isolates of Salmonella wien were of the same biotype, and had the same antibiotic resistance pattern (third generation cephalosporins, monobactams, aminoglycosides, chloramphenicol, trimethoprim and sulphonamides) and plasmid DNA restriction pattern. The isolates were all susceptible to a combination of cefotaxime and clavulanic acid (a beta-lactamase inhibitor), which displayed synergy, suggesting the presence of a beta-lactamase (geometric mean MICs 11.24 micrograms/ml for cefotaxime alone and 0.24 micrograms/ml in combination with 0.1 micrograms/ml potassium clavulanate). All isolates produced TEM-1 and SHV-2 beta-lactamase which was not transferable to Escherichia coli by conjugation. The presence of the SHV-2 enzyme in Salmonella wien may allow it to adapt to newer beta-lactams which is a cause for concern in this hospital.

Molecular epidemiology of an outbreak of multiresistant Klebsiella pneumoniae in a Tunisian neonatal ward

“…In Tunisia, these organisms were identified mainly among paediatric isolates of K. pneumoniae, Salmonella species and Escherichia coli and, as observed in another Tunisian hospital, the majority of our isolates were recovered from blood (Ben Hassen et al, 1990;Hammami et al, 1991;Philippon et al, 1989).…”

Emergence of CTX-M-15 type extended-spectrum β-lactamase-producing Salmonella spp. in Kuwait and the United Arab Emirates

“…In 2004, Salmonella resistant to extended-spectrum cephalosporins were identified in 43 countries encompassing Europe, Latin America, the USA, Taiwan and the Western Pacific (Winokur et al, 2001;Dunne et al, 2000;Li et al, 2005;Su et al, 2005), and its prevalence ranged between 0 and 3.4 %. This is believed to be the first report of CTX-M type ESBLproducing Salmonella in Kuwait and the UAE, and one of the very few reports on the ESBL-producing Salmonella in the Middle East (Hammami et al, 1991;Moubareck et al, 2005). The prevalence of ESBL-producing Salmonella was about 17 % with a higher proportion (73 %) of these attributable to isolates from Kuwait.…”

“…This speculation is supported by the fact that the mobile genetic element ISEcpI, a single copy insertion sequence responsible for mobilization of bla genes and identified upstream of several bla CTX-M genes (Walther-Rasmussen & Høiby, 2004), was found in association with about 72 % of our isolates. The only other ESBL found in Salmonella in the Middle East is SHV-2 type, which was first reported during a nosocomial outbreak of acute gastroenteritis due to 'Salmonella wien' in a neonatal intensive care unit in Tunisia (Hammami et al, 1991).…”

Diarrhoeagenic Escherichia coli as a predominant cause of paediatric nosocomial diarrhoea in India

“…Bacterial agents have mostly been reported to cause outbreaks of nosocomial gastroenteritis. These include Salmonella species (Hammami et al, 1991), C. difficile (Pépin et al, 2004), Shigella species (Paton et al, 1991), Yersinia species (Jarvis, 1992), enteropathogenic Escherichia coli (EPEC) (Boyer et al, 1975;Gross et al, 1976), enterotoxigenic E. coli (ETEC) (Gross et al, 1976) and Vibrio cholerae (Ryder et al, 1986). The most common sources of the organism are an infected infant, the hands of hospital personnel or contaminated articles.…”