Three babies die in pseudomonas outbreak at Belfast neonatal unit

Investigators are trying to identify the most likely source of the pseudomonas outbreak in the neonatal unit of the Royal Jubilee Maternity Hospital in Belfast in which three babies died. All three babies were premature and were in the neonatal intensive care unit.

The hospital has confirmed that a further three premature babies were also infected with Pseudomonas aeruginosa. Of these one has died from other causes and two have recovered. Another five babies have the bacterium on their skin, but this is not causing active infection. The remaining babies in the neonatal unit have no sign of infection.

The hospital said that it had now carried out biodecontamination of the intensive care part of the neonatal unit. However, this will remain closed while a team of specialists continues to try to identify the most likely sources of infection. All the other maternity services and wards at the hospital are working as normal. Babies requiring special neonatal care are being transferred to neighbouring units.

Pseudomonas aeruginosa is a Gram negative bacterium commonly found in soil and groundwater. It is one of the more common causes of healthcare associated infections and is increasingly resistant to many antibiotics. In hospitals the organism can contaminate moist or wet reservoirs such as respiratory equipment and indwelling catheters. Good hand hygiene and infection control measures are essential to help prevent patients contracting the infection.

Northern Ireland’s health minister, Edwin Poots, said, “Babies in neonatal units are already vulnerable due to clinical conditions and varying degrees of prematurity. This makes them less able to withstand infections, including those that would not cause problems in healthy babies.

“I have asked the trust to work with the Public Health Agency to ensure all necessary steps are swiftly taken to identify the source of the infection so that we contain it and reduce further risk of spreading.”

Lorraine Doherty, from Northern Ireland’s Public Health Agency, said: “Pseudomonas bacterium is an organism that can be found in many natural environments, including soil and water. Infections are mainly seen in immunocompromised and debilitated patients.

“Outbreaks of pseudomonas have occurred in intensive care facilities around the world as patients in these facilities are frequently immunocompromised. The Public Health Agency will continue to support the trust in their full investigation of this outbreak.”

There was an outbreak of pseudomonas infection in December in the neonatal intensive care unit at Altnagelvin Hospital in Londonderry in which one baby died. However, the strain of pseudomonas was different from that in the current outbreak, and the Public Health Agency said there was no evidence to link the two.

Surveillance of pseudomonas is not mandatory, so there are no official data on the number of outbreaks in any setting. But information from the Health Protection Agency’s voluntary surveillance scheme shows that cases of bloodstream infections, including those with pseudomonas infections, have generally slightly decreased over recent years.

Pseudomonas aeruginosa infections rarely affect healthy people. In people who are already ill the bacterium can cause a range of infections from mild skin infections to urinary tract infections. They can also cause a variety of bloodstream infections, particularly in patients with serious burns and in those who are severely immunosuppressed. Patients with diabetes mellitus and cystic fibrosis are particularly vulnerable to infection with the bacterium.

Most infections are susceptible to third generation cephalosporins, carbapenems, aminoglycosides, and colistimethate. Serious infections are usually treated with broad spectrum penicillins, often in combination with an aminoglycoside. Experimental vaccines are currently undergoing clinical testing, which may be particularly helpful for patients with cystic fibrosis.