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Journal of Clinical Microbiology, November 2000, p. 4131-4136, Vol. 38, No. 11
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Outbreak of Bacillus cereus Infections in a Neonatal Intensive Care Unit Traced to Balloons Used in Manual Ventilation

Wil C. Van Der Zwet,1 Gerard A. Parlevliet,1 Paul H. Savelkoul,1 Jeroen Stoof,1 Annie M. Kaiser,1 A. Marceline Van Furth,2 and Christina M. Vandenbroucke-Grauls1,*

Departments of Medical Microbiology and Infection Control1 and Pediatrics,2 University Hospital Vrije Universiteit, Amsterdam, The Netherlands

Received 9 March 2000/Returned for modification 8 May 2000/Accepted 14 August 2000

In 1998, an outbreak of systemic infections caused by Bacillus cereus occurred in the Neonatal Intensive Care Unit of the University Hospital Vrije Universiteit, Amsterdam, The Netherlands. Three neonates developed sepsis with positive blood cultures. One neonate died, and the other two neonates recovered. An environmental survey, a prospective surveillance study of neonates, and a case control study were performed, in combination with molecular typing, in order to identify potential sources and transmission routes of infection. Genotypic fingerprinting by amplified-fragment length polymorphism (AFLP) showed that the three infections were caused by a single clonal type of B. cereus. The same strain was found in trachea aspirate specimens of 35 other neonates. The case control study showed mechanical ventilation with a Sensormedics ventilation machine to be a risk factor for colonization and/or infection (odds ratio, 9.8; 95% confidence interval, 1.1 to 88.2). Prospective surveillance showed that colonization with B. cereus occurred exclusively in the respiratory tract of mechanically ventilated neonates. The epidemic strain of B. cereus was found on the hands of nursing staff and in balloons used for manual ventilation. Sterilization of these balloons ended the outbreak. We conclude that B. cereus can cause outbreaks of severe opportunistic infection in neonates. Typing by AFLP proved very useful in the identification of the outbreak and in the analysis of strains recovered from the environment to trace the cause of the epidemic.

* Corresponding author. Mailing address: University Hospital Vrije Universiteit, Department of Medical Microbiology and Infection Control, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. Phone: (31) 20 4440488. Fax: (31) 20 4440473. E-mail: VANDENBROUCKEGRAULS{at}AZVU.NL.

Journal of Clinical Microbiology, November 2000, p. 4131-4136, Vol. 38, No. 11
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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