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An Insidious Nosocomial Outbreak Due to Salmonella enteritidis

Published online by Cambridge University Press:  02 January 2015

Cristina Guallar ,
Javier Ariza ,
Angeles Dominguez ,
Carmen Peña ,
Imma Grau ,
R. Verdaguer ,
LLum Torrens  and
Francisco Gudiol
Cristina Guallar
Affiliation:
Department of Infectious Diseases, Hospital de Bellvitge, Universidad de Barcelona, Spain
Javier Ariza*
Affiliation:
Department of Infectious Diseases, Hospital de Bellvitge, Universidad de Barcelona, Spain
Angeles Dominguez
Affiliation:
Department of Microbiology, Hospital de Bellvitge, Universidad de Barcelona, Spain
Carmen Peña
Affiliation:
Department of Infectious Diseases, Hospital de Bellvitge, Universidad de Barcelona, Spain
Imma Grau
Affiliation:
Department of Infectious Diseases, Hospital de Bellvitge, Universidad de Barcelona, Spain
R. Verdaguer
Affiliation:
Department of Microbiology, Hospital de Bellvitge, Universidad de Barcelona, Spain
LLum Torrens
Affiliation:
Department of Epidemiology, Hospital de Bellvitge, Universidad de Barcelona, Spain
Francisco Gudiol
Affiliation:
Department of Infectious Diseases, Hospital de Bellvitge, Universidad de Barcelona, Spain
*
Infectious Disease Service, Hospital de Bellvitge, C/Feixa Llarga S/N, 08907 l'Hospitalet de Llobregat, Barcelona, Spain
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Abstract

Objectives:

To investigate an increase in the number of Salmonella enteritidis isolates detected in a large hospital to ascertain whether it was due to a nosocomial source, to identify the mechanisms of transmission, and to institute effective control measures to prevent future episodes.

Design:

Observational study, survey of all microbiological samples positive for S. enteritidis detected in the hospital, outbreak investigation, and review of the literature.

Setting:

A tertiary-care teaching hospital for adults in Barcelona, Spain.

Results:

During a 7-month period from May to November 1998, we identified 22 inpatients with S. enteritidis infection for whom nosocomial acquisition was strongly suspected. The attack rate was 0.138 per 1,000 patient-days. All affected patients were immunosuppressed and overall mortality was 41% (9 of 22). A sample of a meal cooked in the kitchen was culture positive for S. enteritidis. All isolates shared the same antibiotic susceptibility pattern and all except one shared the same pulsed-field gel electrophoresis (PFGE) pattern, but PFGE could not differentiate between outbreak-related and control strains. After compliance with kitchen hygiene procedures was emphasized and cleansing was intensified, no more cases were detected.

Conclusions:

Apparently, sporadic cases of S. enteritidis may be part of an outbreak with a low attack rate. A small but persistent inoculum affecting only individuals with special predisposition for Salmonella infection might account for this. Suspicion should be raised in hospitals and institutions with a highly susceptible population.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 1 , January 2004 , pp. 10 - 15
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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