Enterobacter Cloacae Sepsis Outbreak in Neonatal Intensive Care Unit Due to Contaminated Total Parenteral Nutrition Solution

Aim: Outbreaks have been reported in risky clinical settings such as intensive care units. The aim of this report is to address the clinical importance of the sepsis outbreak occurring in a neonatal intensive care unit. Materials and Methods: On the day of the outbreak 45 neonates were hospitalizd in our neonatal intensive care unit. All 13 high-risk neonates in the clinic developed signs and symptoms of septic shock after the initiation of parenteral nutrition solutions. Blood and parenteral nutrition solutions were cultured from all newborns. DNA analysis was also performed using gel electrophoresis to identify the source. Results: Enterobacter cloacae was identified in the blood cultures of 5 patients and in 11 samples of the parenteral solutions. DNA analysis by pulsed-field gel electrophoresis revealed the same profile among the isolates of all Enterobacter cloaceae. Conclusion: The data from this investigation allow for the conclusion that the parenteral nutrition solutions were the source of the outbreak by Enterobacter cloaceae in all 13 newborns. Although the contamination of parenteral nutrition solution may occur in several ways, we think that establishing an action plan in every neonatal intensive care unit for the systematic and strategic approach on managing the risk and crisis of a sepsis outbreak is of great importance.