A 37-week-old infant was delivered by cesarean section and discharged from a Connecticut hospital when he was 10 days old. Two days later he was lethargic and had a fever. When he was readmitted to the hospital, he had multiple brain abscesses caused by Citrobacter koseri. After a prolonged illness, the baby died. A second infant with a normal pregnancy and delivery died of C. koseri meningitis after a short illness. Nine infants in the hospital nursery had umbilical cord colonization by C. koseri. Environmental cultures were negative for hospital equipment tested. How do you identify the source of infection, and what is its normal habitat?
Hi by the above scenario looks like there was an outbreak of C. kosher in the hospital nursery. Now Enterobacter kosher belongs to Enterobacteriaceae family whose members are normal inhabitants of our intestine. It can be isolated from various environmental sources like soil, sewage and as well as human feces. Since according to you environmental sources were negative for it, other possibility is improper hand hygiene practices in the hospital nursery by some staff members. Hand hygiene is an essential step in health care to prevent transmission of microorganisms. A breach in such practice can lead to an outbreak or a solitary hospital acquired infection case or many. In the case submitted by your source of infection probably are hands of healthcare staff or any other person attending these infants.