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An outbreak of skin infections in neonates due to a Staphylococcus aureus strain producing the exfoliative toxin A

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Abstract

Purpose

Staphylococcus aureus is an important cause of infections in hospitalized neonates. Preterm or low birthweight infants are especially at risk to develop a S. aureus infection due to the immaturity of the immune system, length of hospital stay and invasive procedures. Exfoliative toxin (ET)-producing S. aureus is often responsible for neonatal infections, causing clinical manifestations such as staphylococcal scalded skin syndrome, characterized by both localized blisters or generalized exfoliation of the skin.

Methods

We describe an outbreak due to an S. aureus strain producing ETA occurring in a local hospital in Northern Italy. Molecular typing of the isolates included spa typing and multilocus sequence typing. DNA microarray hybridization was also performed on one representative strain.

Results

In the period from July 2013 to February 2014, 12 neonates presented with skin infections, mainly bullae or pustules. Cultures of skin swabs yielded methicillin-susceptible S. aureus (MSSA). By molecular typing, an epidemic strain (t1393/ST5) was identified in nine neonates; microarray analysis and PCR revealed that it contained the ETA encoding gene. Screening of staff, mothers and healthy neonates and environmental cultures did not reveal the presence of the epidemic strain. However, the father of an infected neonate was found to be a carrier of MSSA t1393 five months after the outbreak started.

Conclusion

Implementation of hygiene procedures and sanitization of the ward twice terminated the outbreak. Timely surveillance of infections, supported by molecular typing, is fundamental to prevent similar episodes among neonates.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy

    Fernanda Pimentel de Araujo, Annalisa Pantosti & Monica Monaco

  2. Division of Infectious and Tropical Diseases, Hospital of Lodi, Via Fissiraga 15, 26900, Lodi, Italy

    Marco Tinelli

  3. Diagnostic Department, Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Via Appia Nuova, 1411, 00178, Rome, Italy

    Antonio Battisti

  4. Division of Pediatrics, Hospital of Lodi, Via Fissiraga 15, 26900, Lodi, Italy

    Angela Ercoli

  5. Laboratory of Microbiology, Hospital of Lodi, Via Fissiraga 15, 26900, Lodi, Italy

    Adriano Anesi

Authors
  1. Fernanda Pimentel de Araujo
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  2. Marco Tinelli
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  3. Antonio Battisti
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  4. Angela Ercoli
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  5. Adriano Anesi
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  6. Annalisa Pantosti
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  7. Monica Monaco
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Corresponding author

Correspondence to Annalisa Pantosti.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

Local Surveillance and Infection Control Committee (CIO) approved the study on September 13, 2013. Informed consent was obtained from parents of infected and non-infected neonates and from medical and non-medical staff. Clinical data and samples (bacterial isolates) were anonymized before being used for the study. Approval by the ethics committee was not required as the study was regarded as part of routine surveillance measures for infection control.

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Pimentel de Araujo, F., Tinelli, M., Battisti, A. et al. An outbreak of skin infections in neonates due to a Staphylococcus aureus strain producing the exfoliative toxin A. Infection 46, 49–54 (2018). https://doi.org/10.1007/s15010-017-1084-2

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  • DOI: https://doi.org/10.1007/s15010-017-1084-2

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