Between February and August 1997, 53 patients with enterovirus meningitis were hospitalized in Clermont-Ferrand, France. All but one were children. Echovirus type 30 was involved in 70% of cases with ...identified serotype. The outbreak ceased on August 8. Two months later, a neonate was admitted to the neonatal unit with an echovirus type 30 meningitis thought to be acquired at delivery. Twenty days later a nosocomial outbreak of echovirus type 30 involving five neonates occurred. Two of them presented with meningitis and two with febrile seizure; One was asymptomatic. The retrospective examination of the maternal sera in a neutralization test, using the index case strain as a source of antigen, showed that none of the neonates was passively immunized before hospitalization. The use of genome detection in cerebrospinal fluid allowed rapid diagnosis and infection was contained by re-inforcing hygiene measures. Prospective examination of stools in the neonatal and paediatric units showed no further occurrences of the disease. No sporadic case was observed in the general population. Hence, nosocomial infections can occur a long time after an outbreak in the general population; rapid diagnosis with molecular tools is useful both for a definite diagnosis in patients already hospitalized, and to act as a rapid alert, even in intervals between seasonal outbreaks.
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IJS, IMTLJ, KILJ, KISLJ, NUK, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Les entérovirus peuvent être responsables d'infections nosocomiales épidémiques dans les nurseries et services de néonatalogie même en dehors de la période estivo-automnale, à partir d'un ...patient-index, des membres du personnel ou des visiteurs. Ces infections se traduisent par des méningites prolongeant la durée d'hospitalisation, de même que des pneumonies. Les myocardites et les tableaux gravissimes d'infection généralisée avec coagulation intravasculaire disséminée, moins fréquents, entraînent souvent le décès. Le diagnostic clinique initial peut être difficile. Il faut donc y penser au même titre que les autres causes, réaliser des prélèvements prospectifs (selles et gorge) et, en cas de méningite, rechercher le génome des entérovirus par amplification génique dans le liquide céphalorachidien. Ceci permet un diagnostic rapide, élimine les autres causes et donne l'alerte afin de limiter l'extension de l'infection. Seul le respect des mesures d'hygiène universelles individuelles et collectives, en particulier le lavage des mains et la désinfection des équipements-appareils avec des produits efficaces virucides, permet de lutter contre ces infections dans ces services à haut risque.
Enteroviruses can be responsible for nosocomial outbreaks in nurseries and neonatal units, even during non-epidemic periods, from an index-patient, infected medical staff, or visitors. The most commonly encountered disease is meningitis. Like pneumonia, it lengthens hospital stay. Myocarditis and severe generalized infections with haemorrhagic diasthesis are responsible for a high mortality rate. Early diagnosis may be delayed. Hence the possibility of an enterovirus infection should be systematically suspected and prospective investigations performed (stools, throat swab). In cases of meningitis, enteroviral genome detection in CSF by polymerase chain reaction allows for a rapid diagnosis and, in addition, a rapid alert to prevent nosocomial infection spreading. Extreme vigilance is required if nosocomial infections are to be prevented in nurseries and neonatal units. This includes respect of strict hygiene measures, meticulous handwashing, cleaning and disinfection of surfaces, and efficient virucidal products.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Enteroviruses have been shown to cause severe infections in newborns, and hepatitis is one of the most severe manifestations of this infection. We report a case of fatal hepatic necrosis associated ...with echovirus 20 infection that occurred in a newborn during an outbreak of echovirus 20 infection in France in 1994. This serotype has never been implicated as a cause of severe perinatal echovirus infection. Since the first description of echovirus 20 in 1958, it has only rarely been implicated in outbreaks of disease. We believe that, since echovirus 20 has not been previously reported as a cause of massive hepatic necrosis, the impact of genetic variations in echoviruses should be considered. At present, more than 10% of wild enterovirus strains isolated worldwide fail to type with reference immune sera. Such collected strains should be investigated at a molecular level, and Romero et al. have recently begun such studies of neurovirulent echovirus types.
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BFBNIB, NUK, PNG, UL, UM, UPUK
The effect of a change in the first line antibiotic treatment in a neonatal unit was studied. A total of 238 neonates (G1), admitted between 1 January and 31 July 1989, and treated with gentamicin, ...were compared with 398 (G2) admitted between 1 August 1989 and 31 July 1990 who received amikacin, in the combination of ampicillin plus an aminoglycoside. This change was implemented in an attempt to prevent the spread of an epidemic strain of Enterobacter cloacae resistant to third generation cephalosporins and all aminoglycosides, except amikacin. The change in treatment had no effect on the incidence of nosocomial infections 19.7% (G1) vs. 16.3% (G2) RR = 1.21 (0.86-1.70), but the proportion of patients with nosocomial infections caused by the E. cloacae decreased (6.3% vs. 2.0% RR 3.14 CI 1.35-7.28). Certain trends in the bacterial ecology emerged: E. aerogenes and Enterococci increased in G2. The proportion of gentamicin-resistant strains such as E. cloacae or Staphylococci decreased and there was no increase in aminoglycoside-resistant strains, except in Escherichia coli, in which resistance to amikacin rose from 0 to 3%. This study illustrates the influence of antimicrobial therapy on the species and the resistance of strains isolated in nosocomial infections. It also highlights the need for epidemiologic surveillance, and poses the question of how best to modify antibiotic policy.
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