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An Insidious Nosocomial Outbreak Due to Salmonella enteritidis

  • Cristina Guallar (a1), Javier Ariza (a1), Angeles Dominguez (a2), Carmen Peña (a1), Imma Grau (a1), R. Verdaguer (a2), LLum Torrens (a3) and Francisco Gudiol (a1)...
Abstract<span class='bold'>Objectives:</span>

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.

<span class='bold'>Design:</span>

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

<span class='bold'>Setting:</span>

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

<span class='bold'>Results:</span>

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.

<span class='bold'>Conclusions:</span>

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.

Corresponding author
Infectious Disease Service, Hospital de Bellvitge, C/Feixa Llarga S/N, 08907 l'Hospitalet de Llobregat, Barcelona, Spain
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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