Epidemic gram-negative bacteremia in a neonatal intensive care unit in Guatemala

Am J Infect Control. 1994 Jun;22(3):163-71. doi: 10.1016/0196-6553(94)90005-1.


Background: Nosocomial bloodstream infection is an important cause of morbidity and mortality among neonates. From September 1 through December 5, 1990 (epidemic period), gram-negative bacteremia developed in 26 neonates after their admission to the neonatal intensive care unit (NICU) of Hospital General, a 1000-bed public teaching hospital in Guatemala with a 16-bed NICU. Twenty-three of the 26 patients (88%) died.

Methods: To determine risk factors for and modes of transmission of gram-negative bacteremia in the NICU, we conducted a cohort study of NICU patients who had at least one blood culture drawn at least 24 hours after admission to the NICU and performed a microbiologic investigation in the NICU.

Results: The rate of gram-negative bacteremia was significantly higher among patients born at Hospital General, delivered by cesarian section, and exposed to selected intravenous medications and invasive procedures in the NICU during the 3 days before the referent blood culture was obtained. During the epidemic period, the hospital's chlorinated well-water system malfunctioned; chlorine levels were undetectable and tap water samples contained elevated microbial levels, including total and fecal coliform bacteria. Serratia marcescens was identified in 81% of case-patient blood cultures (13/16) available for testing and from 57% of NICU personnel handwashings (4/7). Most S. marcescens blood isolates were serotype O3:H12 (46%) or O14:H12 (31%) and were resistant to ampicillin (100%) and gentamicin (77%), the antimicrobials used routinely in the NICU.

Conclusions: We hypothesize that gram-negative bacteremia occurred after invasive procedures were performed on neonates whose skin became colonized through bathing or from hands of NICU personnel.

Publication types

  • Comparative Study

MeSH terms

  • Bacteremia / epidemiology*
  • Bacteremia / transmission
  • Cohort Studies
  • Cross Infection / epidemiology*
  • Cross Infection / transmission
  • Delivery, Obstetric / methods
  • Disease Outbreaks*
  • Female
  • Gram-Negative Bacteria / isolation & purification
  • Gram-Negative Bacterial Infections / epidemiology*
  • Gram-Negative Bacterial Infections / transmission
  • Guatemala / epidemiology
  • Hand Disinfection
  • Humans
  • Infant Care
  • Infant, Newborn
  • Intensive Care Units, Neonatal*
  • Male
  • Personnel, Hospital
  • Pregnancy
  • Risk Factors
  • Water Microbiology