Investigating transmission patterns among preterm neonates during an outbreak of necrotizing enterocolitis related to Clostridium butyricum using whole-genome sequencing

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES Journal of Hospital Infection Pub Date : 2024-07-31 DOI:10.1016/j.jhin.2024.07.009

C. Sartor , Y. Mikrat , I. Grandvuillemin , A. Caputo , I. Ligi , A. Chanteloup , G. Penant , P. Jardot , F. Romain , A. Levasseur , F. Boubred , B. La Scola , N. Cassir

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Abstract

Background

Necrotizing enterocolitis is the most severe life-threatening acquired gastrointestinal disorder among preterm neonates. We describe here an outbreak of Clostridium butyricum-related necrotizing enterocolitis in preterm neonates that occurred in three different neonatal centres, in southeast France.

Methods

We defined a confirmed case of C. butyricum-related necrotizing enterocolitis in preterm neonates by the presence of clinical signs according to modified Bell criteria and C. butyricum identified from stool samples using real-time polymerase chain reaction or culture. A phylogenetic analysis of the isolated strains by whole-genome sequencing was also performed.

Results

Between 5^th and 27^th January 2022, we identified 10 confirmed cases of C. butyricum-related necrotizing enterocolitis, including five from Neonatal Centre 1, four from Neonatal Centre 2, and one from Neonatal Centre 3. The attack rate of necrotizing enterocolitis in Neonatal Centre 1 was 7.1% (5/70). The positivity rate of C. butyricum detected from stool samples was higher during the outbreak period (37/276; 13.4%) than outside this period (7/369; 1.9%), while systematic screening was maintained (P<0.001). Phylogenetic analysis showed a clonality between strains inside four clusters. Two clusters included neonates hospitalized in different neonatal centres, suggesting the transmission of C. butyricum strains during the transfer of neonates between neonatal centres.

Conclusions

This outbreak of C. butyricum-related necrotizing enterocolitis confirms a cross-transmission between preterm neonates, including twin or triplet siblings, and involving necrotizing enterocolitis cases together with asymptomatic carriers. After three months of follow-up, no further cases were identified following the implementation of contact precautions with sporicidal agents.

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利用全基因组测序技术调查与丁酸梭菌有关的坏死性小肠结肠炎爆发期间早产新生儿的传播模式。

背景：坏死性小肠结肠炎是早产新生儿中最严重的危及生命的后天性胃肠道疾病。我们在此描述在法国东南部三个不同的新生儿中心爆发的早产新生儿丁酸梭菌相关坏死性小肠结肠炎：我们根据修改后的贝尔标准对早产新生儿坏死性小肠结肠炎的确诊病例进行了定义，即出现临床症状，并通过实时聚合酶链反应或培养从粪便样本中鉴定出丁酸梭菌。此外，还通过全基因组测序对分离的菌株进行了系统发育分析：结果：2022年1月5日至27日期间，我们发现了10例与丁酸杆菌相关的坏死性小肠结肠炎确诊病例，其中5例来自新生儿中心1，4例来自新生儿中心2，1例来自新生儿中心3。新生儿中心 1 的坏死性小肠结肠炎发病率为 7.1%（5/70）。在疫情爆发期间，从粪便样本中检测到的丁酸杆菌阳性率（37/276；13.4%）高于疫情爆发期间之外的阳性率（7/369；1.9%），而系统筛查仍在进行（PConclusions：这次与丁酸杆菌相关的坏死性小肠结肠炎疫情证实了早产新生儿（包括双胞胎或三胞胎兄弟姐妹）之间的交叉传播，涉及坏死性小肠结肠炎病例和无症状携带者。经过三个月的随访，在使用杀菌剂采取接触预防措施后，没有再发现病例。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.