Nosocomial infections in very low birthweight infants in Germany: current data from the National Surveillance System NEO-KISS.

BACKGROUND: Infants with very low birthweight (< 1 500 g, VLBW) are at increased risk for nosocomial infections (NI). In 2 000, we implemented a surveillance system for VLBW infants in Germany: NEO-KISS. In 2005, a joint committee of healthcare providers and insurance companies required German neonatology departments to participate. As a result, NEO-KISS is now a nationwide surveillance system for NI in VLBW infants. PATIENTS AND METHODS: We present NEO-KISS data collected between 2007 and 2011 by 228 neonatology departments. Rates of sepsis, pneumonia and necrotising enterocolitis (NEC) were calculated. In order to evaluate the department-specific infection rate we introduced a new indicator: the Standardised Infection Rate (SIR). The SIR considers the department-specific patient distribution (based on the patients' birthweight) and describes the ratio of observed and expected infections (calculated from the reference data for this individual patient distribution). The data presented comprise 33 048 VLBW infants.The incidence density of CVC-associated sepsis 8.6 per 1 000 CVC-days. RESULTS AND CONCLUSION: The incidence of pneumonia among mechanically ventilated patients was 2.7/1 000 ventilator days. The incidence of NEC was 0.8. The SIR showed strong variation among the participating departments. It is an excellent tool for identifying outliers in nosocomial infection rates and for stimulating activities to decrease the risk of nosocomial infections.

Spontaneous and experimental intoxication of cattle by Simarouba versicolor A. St.-Hill (Simaroubaceae).

This study describes an outbreak of Simarouba versicolor intoxication in cattle from Mato Grosso do Sul, Brazil, and reproduces it experimentally. Clinical signs of the affected animals were weakness, tremors, hind limbs incoordination, reluctance to move, sternal and lateral recumbency and death. The main necropsy findings, observed in the abomasum and in segments of the small and large intestines, were diffuse redness and mucosal and serosal swelling. Histological examination revealed necrosis of lymphoid tissues and necrotizing enterocolitis. One experiment was carried out using 3 male calves to test the toxicity of a single dose of S. versicolor leaves at 15 g/kg, 5 g/kg and 2.5 g/kg. Clinical signs, necropsy findings and histological examination of calves receiving 15 g/kg and 5 g/kg leaves were similar to those of cattle from the intoxication outbreak. The calf fed 2.5 g/kg leaves developed clinical symptoms of poisoning and recovered naturally. In a second experiment, two male calves received daily administration of S. versicolor leaves at 1.5 g/kg and 2.5 g/kg for 10 days. They developed clinical signs of intoxication within 24 h and recovered eight to nine days after the leaves were administered. These findings suggest that S. versicolor was responsible for the outbreak studied, although this plant does not have cumulative intoxication effects on cattle.

Clostridia as agents of zoonotic disease.

Clostridia are not normally considered to be zoonotic pathogens, although many species affect both humans and domestic animals. Three cases in which organisms occur, possibly via direct or indirect transmission, in both food animals and humans are considered here. Strains of Clostridium perfringens that produce enterotoxin (CPE) are typically transmitted to humans in contaminated, improperly handled foods. Pathogenesis is based upon action of CPE in the intestine, and disease is usually self-limiting. Infection of domestic animals by CPE-producing C. perfringens is uncommon. C. perfringens type C is best known as a pathogen of neonatal domestic animals, which acquire the infection from the dam. The course may be peracute, and prevention by vaccination of the dam is universally advocated. Humans consuming meat contaminated with type C may develop enteritis necroticans, with segmental hemorrhagic and necrotic jejunitis, which must usually be treated by bowel resection. Clostridium difficile is a pathogen of both humans and domestic animals. Examination of retail meats by bacteriologic culture has revealed genotypes of C. difficile that in many cases are identical to those from food animals and diseased humans. Transmission, food animals to foods to humans, has not been documented.

[Enterobacter sakazakii in powdered infant formula]. / Gesundheitliches Gefährdungspotenzial von Enterobacter sakazakii (Cronobacter spp. nov.) in Säuglingsnahrung.

Under inadequate hygienic conditions, opportunistic bacteria may multiply in powdered infant formula (PIF) and cause severe, often fatal neonatal infections. Enterobacter sakazakii has obtained Public Health relevance causing neonatal meningitis (often fatal), bacteremia and necrotizing enterocolitis. At highest risk are neonates up to two months of age. The new genus designation Cronobacter spp. nov. has been proposed to replace Enterobacter sakazakii. Enterobacter sakazakii is relatively resistant to osmotic and dry stress and may survive in PIF more than 2 years. (Inter)national organisations (EFSA, FAO, WHO, ESPGHAN, DGKJ, OGKJ, ISO) published their opinions recently. Manufacturers can minimize the risk of contamination of PIF by continuously improving technologies and by microbiological surveillance. Institutional and private consumers may reduce the risk of infection by using appropriate hygienic procedures.

An epidemic of gastroenteritis and mild necrotizing enterocolitis in two neonatal units of a University Hospital in Rome, Italy.

In the summer of 1999 a cluster of 18 cases of necrotizing enterocolitis (NEC) occurred in a University Hospital in Rome, Italy. The cases presented with mild clinical and radiological signs, and none died. Seventy-two per cent had a birth weight of > 2500 g, 66.7% had a gestational age of > 37 weeks, 30% presented with respiratory diseases and/or hypoglycaemia. All cases occurred within 10 days of birth and between 5 and 7 days after two clusters of diarrhoea (14 cases). The NEC outbreak had two phases; most cases in the first phase occurred in the at-risk unit, whereas those in the second phase occurred in the full-term unit. In the multivariate analysis, invasive therapeutic procedures, pathological conditions and formula feeding were associated with NEC. Although no predominant common bacteria were isolated, we suggest an infective origin of this outbreak.