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Epidemic Nosocomial Meningitis Due to Citrobacter diversus in Neonates

D. R. Graham, R. L. Anderson, F. E. Ariel, N. J. Ehrenkranz, B. Rowe, H. R. Boer and R. E. Dixon
The Journal of Infectious Diseases
Vol. 144, No. 3 (Sep., 1981), pp. 203-209
Published by: Oxford University Press
Stable URL: http://www.jstor.org/stable/30112462
Page Count: 7
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Epidemic Nosocomial Meningitis Due to Citrobacter diversus in Neonates
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Abstract

Five infants born at one hospital over a two-year period developed meningitis due to a serotype 02 strain of Citrobacter diversus; four infants developed brain abscesses due to this organism. The initial prevalence of stool colonization in infants was 79%; eventually 140 infants (10%) and six nurses (6%) were found to be colonized. One colonized infant remained in the hospital for the entire two-year period. The strains were of two biotypes marked by the presence (biotype d) or absence (biotype a) of fermentation of sucrose and dulcitol. The biotype d strain was found in the five infants with meningitis, 110 asymptomatic infants, and five nurses. The biotype a strain, which was isolated from 30 infants and one nurse, did not cause disease. Colonized infants were distinguished by intensive care therapy (P = $10^{-31}$), gavage feeding (P = 0.036), and prenatal intrauterine monitoring (P = 0.037). These findings suggest a fecal reservoir and person-to-person transmission of C. diversus. Measures to control the outbreak cost about $110,000.

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