The Indian Journal of Pediatrics

, Volume 76, Issue 6, pp 629–633 | Cite as

Salmonella typhimurium outbreak in a neonatal unit in Turkey

  • Murat AnilEmail author
  • Mehmet Helvaci
  • Nisel Ozkalay
  • Esra Toprak
  • Ayse Berna Anil
  • Mustafa Dilek
  • Neval Agus
Original Article



To analyze an outbreak caused by a multipl resistant strain of S. typhimurium in a newborn unit in Turkey.


The outbreak occured during the period 15 to 29 March,2005. A newborn infected with S. typhimurium was defined as a case. Newborns who were hospitalized during the outbreak period with no diagnosis of S. typhimurium infections (n=50) constituted the control group I (CG I). The matched patients of the control group II (CG II) (n=20) were selected from neonates without S. typhimurium infections during the period.


Of 22 infants who were affected two died. Cases developed diarrhea (n=20), septicemia (n=5) and meningtis (n=1). The strain was resistant to ampicillin, ceftriaxone, ceftazidime, amikacin, trimethoprim-sulfamethoxasole and chloromphenicol, susceptible to meropenem. All of the infected neonates were treated with meropenem. The surveillance cultures were negative. The outbreak was controlled by approprite therapy and institution of effective control measures. The cases were more exposed to mechanical ventilation than CG I (p<0.05). The mean additional length of stay in cases was significantly different from CG II (14.9 days vs. 5.1 days, p<0.05). The mean charges was $1588.78 for a case and $506.94 for a control (P<0.05). Accommodation accounted for 44.5% of these extra charges.


This study increases the understanding of the burden of multidrug-resistant S. typhimurium infection. Nosocomial outbreaks have a major effect on healthcare delivery, costs and outcomes.

Key words

Neonates Outbreak Salmonella typhimurium Risk factors Additional length of stay Extra charge 


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  1. 1.
    Bouallegue-Godet O, Ben Salem Y, Fabre L, Demartin M, Grimont PA, Mzoughi R et al. Nosocomial outbreak caused by Salmonella enterica serotype Livingstone producing CTXM-27 extended-spectrum β-lactamase in a neonatal unit in Sousse, Tunisia. J Clin Microbiol 2005; 43: 1037–1044.PubMedCrossRefGoogle Scholar
  2. 2.
    Yong D, Lim YS, Yum JH, Lee h, Lee K, Kim EC et al. Nosocomial outbreak of pediatric gastroenteritis caused by CTX-M-14-type extended spectrum â-lactamase-producing strains of Salmonella enterica serovar London. Clin Microbiol 2005; 43: 3519–3521.CrossRefGoogle Scholar
  3. 3.
    Lamb VA, Mayhall CG, Spadora AC, Markowitz SM, Farmer III JJ, Dalton HP. Outbreak of Salmonella typhimurium gastroenteritis due to an imported strain resistant to ampicillin, chloramphenicol, and trimethoprimsulfamethoxazole in a nursery. J Clin Microbiol 1984; 20: 1076–1079.PubMedGoogle Scholar
  4. 4.
    Vaagland H, Blomberg B, Krüger C, Naman N, Jureen R, Langeland N. Nosocomial outbreak of Salmonella enterica serotype Enteritidis meningitis in a rural hospital in northern Tanzania. BMC Infectious Diseases 2004; 4: 35.PubMedCrossRefGoogle Scholar
  5. 5.
    Bopp CA, Brenner FW, Fields PI, Wells JG, Strockbine NA. Eschericia, Shigella, Salmonella. In Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH eds. Manuel of Clinical Microbiology, 8th ed. Washington DC; American Society for Microbiology. 2003; 654–671.Google Scholar
  6. 6.
    Popoff MY, Bockemuhl J, Gheesling LL. Kauffmann-White scheme. Res Microbiol 2003; 154: 173–174.PubMedCrossRefGoogle Scholar
  7. 7.
    Clinical and Laboratory Standards Institute. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Pennsylvania; Clinical and Laboratory Standards Institute, 2005. Approved standard M7-A6.Google Scholar
  8. 8.
    Pessao-Silva CL, Toscano CM, Moreira BM, Santos AL, Frota AC, Solari CA et al. Infection due to extended-spectrum-beta-lactamase-producing Salmonella enterica subsp. tenterica serotype infants in a neonatal unit. J Pediatr 2002; 141: 381–387.CrossRefGoogle Scholar
  9. 9.
    Sarvikiki E, Lyytikainen O, Salmenlinna S, Vuopio-Varkila J, Luukkainen P, Tarkka E et al. Clustering of Serratia marcescens infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2004; 25: 723–729.CrossRefGoogle Scholar
  10. 10.
    Cartelle M, Tomas MM, Pertege S, Beceiro A, Dominquez MA, Velasco D et al. Risk factors for colonization and infection in a hospital outbreak caused by a strain of Klebsiella pneumoniae with reduced susceptibility to expanded-spectrum cephalosporins. J Clin Microbiol 2004; 42: 4242–4249.PubMedCrossRefGoogle Scholar
  11. 11.
    Dolinger de Brito D, Oliveire EJ, Abdallah VOS, Darini ALC, Filho PG. An outbreak of Acinetobacter baumaaii septicemia in a neonatal intensive care unit of a university hospital in Brazil. Brazilian J Infect Dis 2005; 9: 301–309.Google Scholar
  12. 12.
    Aziz K, McMillan DD, Andrews W, Pendray M, Qiu Z, Karuri S et al. Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related. BMC Pediatr 2005; 5: 22.PubMedCrossRefGoogle Scholar
  13. 13.
    Pessoa-Silva CL, Miyasaki CH, de Almedida MF, Kopelman BI, Raggio RL, Wey SB. Neonatal late-onset blooddstream infection: attributable mortality, excess of length of stay and risk factors. Eur J Epid 2001; 17: 715–720.CrossRefGoogle Scholar
  14. 14.
    Kruger T, Szabo D, Keddy KH, Deeley K, Marsh JW, Hujer AM et al. Infections with nontyphoidal Salmonella species producing TEM-63 or a novel TEM enzyme, TEM-131 in South Africa. Antimicrob Agents Chemother 2004; 48: 4263–4270.PubMedCrossRefGoogle Scholar
  15. 15.
    Gales AC, Sader HS, Mendes RE, Jones RN. Salmonella spp. isolates causing bloodstream infections in Latin America: report of antimicrobial activity from the Sentary Antimicrobial Surveillance Program (1997–2000). Diagn Microbiol Infect Dis 2002; 44: 313–318.PubMedCrossRefGoogle Scholar
  16. 16.
    Winokur PL, Canton R, Casellas JM, Legakis N. Variations in the prevalence of strains expressing an extended-spectrum beta lactamase phenotype and characterization of isolates from Europe, the Americans, and the Western Pacific region. Clin Infect Dis 2001; 32: 94–103.CrossRefGoogle Scholar
  17. 17.
    Kilic D, Tulek N, Tuncer G, Doganci L, Willke A. Antimicrobial susceptibilities and ESBL production rates of Salmonella and Shigella strains in Turkey. Clin Microbial Infect 2001; 7: 341–342.CrossRefGoogle Scholar
  18. 18.
    Otkun M, Erdem B, Akata, Tatman-Otkun M, Gerceker D, Yagci SF et al. Antimicrobial resistance patterns and plasmid profiles of Salmonella typhimurium isolates in Turkey. Eur J Clin Microbiol Infect Dis 2001; 20: 206–209.PubMedCrossRefGoogle Scholar
  19. 19.
    Yalçýn NA. Socioeconomic burden of nosocomial infections. Indian J Med Sci 2003; 57: 450–456.Google Scholar
  20. 20.
    Mahieu LM, Buitenweg N, Beutels P, De Dooy JJ. Additional hospital stay and due to hospital-acquired infection in a neonatal unit. J Hosp Infect 2001; 47: 223–229.PubMedCrossRefGoogle Scholar
  21. 21.
    Haley RW. Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. Am J Med 1991; 91: 32–38.CrossRefGoogle Scholar
  22. 22.
    Girard R, Fabry J, Maynet R, Lambert DC, Sepetjan M. Costs of nosocomial infections in a neonatal unit. J Hosp Infect 1983; 13: 361–366.CrossRefGoogle Scholar
  23. 23.
    Leroyer A, Bedu A, Lombrail P, Desplanques L, Diakite B, Bingen E et al. Prolangation of hospital stay and extra costs due to hospital-acquired infection in a neonatal unit. J Hosp Infect 1997; 35: 37–45.PubMedCrossRefGoogle Scholar
  24. 24.
    Rogowski J. Measuring the costs of neonatal and perinatal care. Pediatrics 1999; 103: 329–335.PubMedGoogle Scholar
  25. 25.
    Zernikow B. Holtmannspötter K, Michel E, Hornschuh F, Groote K, Hennecke KH. Predicting lenght of stay in preterm neonates. Eur J Pediatrics 1999; 158: 59–62.CrossRefGoogle Scholar
  26. 26.
    Stone PW, Gupta A, Loughrey M, Della-Latta P, Cimiotti J, Larson E et al. Attributable costs and length of stay of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae outbreak in a neonatal intensive care unit. Infect Hosp Epidemiol 2003; 24: 601–606.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2009

Authors and Affiliations

  • Murat Anil
    • 1
    Email author
  • Mehmet Helvaci
    • 1
  • Nisel Ozkalay
    • 2
  • Esra Toprak
    • 1
  • Ayse Berna Anil
    • 1
  • Mustafa Dilek
    • 1
  • Neval Agus
    • 2
  1. 1.Department of PediatricsTepecik Educational and Research HospitalIzmirTurkey
  2. 2.Department of MicrobiologyTepecik Educational and Research HospitalIzmirTurkey

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