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Nosocomial Neonatal Listeria monocytogenes Transmission by Stethoscope

Fullerton, Lucy MBChB, MRCPCH; Norrish, Gabrielle BM BCh, MRCPCH; Wedderburn, Catherine J. MBChB, MRCPCH; Paget, Stephanie MBChB, MRCPath; Basu Roy, Robin MBChB, MRCPCH; Cane, Clare MBChB, MRCPCH

The Pediatric Infectious Disease Journal: September 2015 - Volume 34 - Issue 9 - p 1042–1043
doi: 10.1097/INF.0000000000000789
Letters to the Editor
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Barnet General Hospital London, United Kingdom

Academic Department of Paediatrics Paediatric Infection and Immunity Imperial College London London, United Kingdom Barnet General Hospital London, United Kingdom

Barnet General Hospital London, United Kingdom

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Lucy Fullerton, MBChB, MRCPCH; E-mail: lucy.fullerton@nhs.net.

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To the Editors:

We report the nosocomial transmission of Listeria monocytogenes IV4.47, from a premature baby with early onset sepsis to a term baby with late onset meningitis. Root cause analysis identified a physician’s stethoscope as the likely mode of transmission.

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Case 1

A premature baby (30 + 2 weeks) had probable Listeria infection. The mother had a flu-like illness for 2 days before delivery. The membranes spontaneously ruptured 8 hours before delivery with meconium-stained liquor. Maternal vaginal and placental swabs grew Listeria monocytogenes, and she was treated with intravenous (IV) cefuroxime and metronidazole. The baby was born by emergency caesarean section in poor condition attended by the Neonatal Registrar and Senior House Officer (SHO1) during the day. The baby had pustules and petechiae on the trunk with thrombocytopenia and was treated intravenously with benzylpenicillin, gentamicin and amoxicillin. The cerebrospinal fluid (CSF) was blood stained, protein was 2.01 g/L and the CSF/serum glucose ratio was 0.57. CSF and blood cultures were negative but were collected following the first dose of antibiotics. The baby received 3 weeks of amoxicillin and 2 weeks of gentamicin.

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Case 2

Nine hours prior, a term baby was born by vaginal breech delivery in the labor ward operating theater. The delivery was attended by the night Registrar and SHO (SHO2). The baby was discharged from the postnatal ward later that day following routine examination by SHO1. Ten days later, the baby was readmitted with fever and irritability. CSF white cell count was 768 μL polymorphonuclear cells 20%, mononuclear cells 80%, red cell count 10 μL, glucose 1.9 mmol/L, serum glucose 5.2 mmol/L, (ratio 0.37), protein 1.64 g/L. Listeria monocytogenes was isolated from CSF. The baby was treated with 3 weeks of IV amoxicillin and 5 days of gentamicin.

Isolates from case 2 and the mother of case 1 were sent to the Health Protection Agency reference laboratory for molecular typing (fluorescent amplified fragment length polymorphism).1 Both isolates were lineage IV serotype 4.47, a rare strain of Listeria that had not previously been isolated from other human cases or from foods within the London area in 2013.

Root cause analysis revealed the only common factor between the 2 babies was SHO1. Handwashing guidelines were adhered to and the 2 babies did not share a geographic location or cot within the hospital at any time. The resuscitation equipment was changed in between the births, and case 2 came into contact with the equipment 9 hours before case 1 was born. The most likely mode of transmission was SHO1’s stethoscope. Both babies made a good recovery.

Transmission within neonatal units has been described between babies in the same room2 and within the delivery suite through shared resuscitation equipment.3

The stethoscope is a proven source of nosocomial infection.4 National guidelines refer to policies to reduce nosocomial transmission5; however, these can be poorly adhered to.4 These cases highlight the importance of following infection control policies.

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ACKNOWLEDGMENTS

The authors are very grateful to the families of both patients involved in the cases and Dr. Corinne Amar, Head of the Foodborne Pathogen Reference Services, Public Health England.

Lucy Fullerton, MBChB, MRCPCH

Gabrielle Norrish, BM BCh, MRCPCH

Catherine J. Wedderburn, MBChB, MRCPCH

Stephanie Paget, MBChB, MRCPath

Barnet General Hospital London, United Kingdom

Robin Basu Roy, MBChB, MRCPCH

Academic Department of Paediatrics Paediatric Infection and Immunity Imperial College London London, United Kingdom Barnet General Hospital London, United Kingdom

Clare Cane, MBChB, MRCPCH

Barnet General Hospital London, United Kingdom

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REFERENCES

1. Roussel S, Félix B, Grant K, et al. Fluorescence amplified fragment length polymorphism compared to pulsed field gel electrophoresis for Listeria monocytogenes subtyping. BMC Microbiol. 2013;13:14
2. Hof H, Lampidis R, Bensch J. Nosocomial listeria gastroenteritis in a newborn, confirmed by random amplification of polymorphic DNA. Clin Microbiol Infect. 2000;6:683–686
3. Simmons MD, Cockcroft PM, Okubadejo OA. Neonatal listeriosis due to cross-infection in an obstetric theatre. J Infect. 1986;13:235–239
4. Bandi S, Conway A. Question 2. Does regular cleaning of stethoscopes result in a reduction in nosocomial infections? Arch Dis Child. 2012;97:175–177
5. . NHS Professionals: Standard Infection Control Policies 2010. http://www.nhsprofessionals.nhs.uk/download/comms/cg1_nhsp_standard_infection_control_precautions_v3.pdf. Accessed March 12, 2015
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