Affiliations: Children's Hospital Medical Center, University of
Bonn, Bonn, Germany | Institute for Medical Microbiology, Immunology and
Parasitology, University of Bonn, Bonn, Germany | Institute for Hygiene and Public Health, University of
Bonn, Bonn, Germany | Institute of Hospital Hygiene, Klinikum Stuttgart,
Stuttgart, Germany
Note: [] Correspondence: Arne Simon, MD, PhD, Children's Hospital Medical
Center University of Bonn, Adenauerallee 119, 53113 Bonn, Germany. Tel.: +49
22828733254; Fax: +49 22828733301; E-mail: asimon@ukb.uni-bonn.de
Abstract: Several outbreaks of Pseudomonas aeruginosa have been
published in neonatal and pediatric patients, but no systematic analysis is
available. Medline and outbreak-database search, systematic analysis of
outbreak reports (confirmed by genotyping). Twenty-four studies were included.
Outbreaks caused by P. aeruginosa resulted in high morbidity (median
clinical infection rate: 68%; range: 0–100%), mortality (median 27%;
0–100%) and resource consumption in neonatal and pediatric inpatient
facilities. In most cases, these outbreaks indicate certain breaches in basic
hygienic practices or are due to the persistence of P. aeruginosa in
environmental vectors and reservoirs (tap water, medical devices, and fomites).
The majority of the reported isolates displayed multi-resistance to first-line
antibiotics. The clinical observation of two or more temporally related cases
of nosocomial P. aeruginosa infections should raise the suspicion of an
outbreak particularly in high-risk pediatric patient populations (neonatal
intensive care unit, pediatric intensive care unit, oncology) and when the
isolate displays resistance to two or more first-line antibiotics. Strict
hygienic barrier precautions should immediately be implemented, re-educated and
supervised. Well-planned environmental culturing should be performed, paying
special attention to water, water outlets, sinks and other wet areas, to
identify environmental reservoirs. A water safety plan based on the WHO
Guidelines for Drinking Water Quality must be introduced. The current strategy
of empiric antibiotic treatment should be investigated by an infectious
diseases' specialist. Genotyping of the isolates by pulse-field gel
electrophoresis should be performed, but any interventions to interrupt further
nosocomial spread should be carried out without waiting for the results.
