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Outbreaks in the neonatal ICU: a review of the literature

Johnson, Juliaa; Quach, Carolineb,c

Current Opinion in Infectious Diseases: August 2017 - Volume 30 - Issue 4 - p 395–403
doi: 10.1097/QCO.0000000000000383

Purpose of review: Neonates in the neonatal ICU (NICU) are uniquely vulnerable to colonization and infection with pathogens such as multidrug resistant Gram-negative bacteria, which in turn are associated with increased infection-related morbidities and higher case-fatality rates. We reviewed the English, French, and German language literature published between 2015 and 2017, for reports of NICU outbreaks.

Recent findings: A total of 39 outbreaks in NICUs were reported with Gram-negative bacteria (n = 21; 54%) causing most, and extended spectrum beta-lactamase-producing organisms being the most frequent resistance mechanism reported (n = 5). Five viral outbreaks were reported (respiratory syncytial virus = 3). A significant proportion of outbreaks (33%) did not identify a source. Whole genome sequencing was used more (n = 6 reports). The most common described infection prevention and control interventions included staff and parent education on hand hygiene, patient isolation, additional contact precautions, including discontinuation of ‘kangaroo care’, and cohorting. Reporting and publication bias are likely common.

Summary: NICUs must be vigilant in identifying outbreaks, conduct comprehensive investigations, and implement targeted infection prevention and control strategies. Molecular epidemiology capacities are an essential element in outbreak investigation. More studies are needed to determine the added value of active colonization screening and their impact on outbreak development.

aDivision of Maternal-Fetal Medicine, Department of Paediatrics, Johns Hopkins University, Baltimore, Maryland, USA

bInfection Prevention and Control Unit, Department of Medical Microbiology, CHU Sainte-Justine

cDepartment of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montreal, Quebec, Canada

Correspondence to Caroline Quach, MD, MSc, Infection Prevention and Control Unit, Department of Medical Microbiology, CHU Sainte-Justine, 3175 Cote Sainte-Catherine, Suite B.17.102, Montreal, QC, Canada H3T 1C5. Tel: +1 514 345 4931x7430; e-mail:

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