Affiliations: Department of Pediatrics, Dr. Soetomo Hospital,
Airlangga University, Surabaya, Indonesia | Institute of Postgraduate Childhood Studies, Ain Shams
University, Cairo, Egypt | Department of Newborn Services, The George Washington
University Hospital, Washington, DC, USA
Note: [] Correspondence: Hany Aly, M.D., Department of Newborn Services,
The George Washington University Hospital, 900 23rd Street, NW, Suite
G2092, Washington, DC 20037, USA. Tel.: +1 202 715 5350; Fax: +1 202 715 5354;
E-mail: haly@mfa.gwu.edu
Abstract: Infections are responsible for significant mortality and long-term
morbidity for infants in the neonatal intensive care unit (NICU). We are
reporting an outbreak of neonatal cellulites and sepsis caused by a unique
species of Salmonella (Salmonella worthington). We also provide the
steps that were initiated in order to control such an unusual epidemic. Our aim
is to increase awareness of the community to this rare but serious infection
with its unique presentation, and re-emphasize the importance of hand hygiene
in the control of infections. This is a retrospective observational study. Data
on septicemia and cellulites were collected during January-October 2002 and
January-October 2003 in the NICU at Dr. Soetomo hospital. A total of 24 infants
with cellulites-septicemia were identified during the period of January-October
2002. Of them 12 cases died. Blood culture of all cases grew S.
worthington. All infections occurred during the first 3 days of life. Only one
case was identified in the period of January-October 2003; this infant
survived. All of the isolates recovered were sensitive to amikacin,
chloramphenicol, and meropenem, while resistant to ampicillin. Two third of the
cases were sensitive to cefopime 66% Environmental cultures recovered
S. worthington from hands of healthcare providers. Outbreaks of S.
worthington in NICU have high case-fatality rate, but can be efficiently
controlled with hand washing or hand spraying. Cellulites in the newborn are a
warning sign for infection with S. worthington.
Keywords: NICU, sepsis, infants, alcohol-glycerin mixture, hand washing
