Background: Escherichia coli (E. coli) comprise part of the normal vaginal microflora. Transfer from mother to\nneonate can occur during delivery resulting, sometimes, in neonatal bacterial disease. Here, we aim to report the\nfirst outbreak of CTX-M ESBL-producing E. coli with evidence of mother-to-neonate transmission in an Irish neonatal\nintensive care unit (NICU) followed by patient-to-patient transmission.\nMethods: Investigation including molecular typing was conducted. Infection was defined by clinical and laboratory\ncriteria and requirement for antimicrobial therapy with or without positive blood cultures. Colonisation was\ndetermined by isolation without relevant symptoms or indicators of infection.\nResults: Index case was an 8-day-old baby born at 34 weeks gestation who developed ESBL-producing E. coli\ninfections at multiple body sites. Screening confirmed their mother as colonised with ESBL-producing E. coli. Five\nother neonates, in the NICU simultaneously with the index case, also tested positive. Of these, four were colonised\nwhile one neonate developed sepsis, requiring antimicrobial therapy. The second infected neonate�s mother was\nalso colonised by ESBL-producing E. coli. Isolates from all eight positive patients (6 neonates, 2 mothers) were\ncompared using pulsed-field gel electrophoresis (PFGE). Two distinct ESBL-producing strains were implicated, with\nevidence of transmission between mothers and neonates for both strains. All isolates were confirmed as CTX-M\nESBL-producers. There were no deaths associated with the outbreak.\nConclusions: Resources were directed towards control interventions focused on hand hygiene and antimicrobial\nstewardship, which ultimately proved successful. Since this incident, all neonates admitted to the NICU have been\nscreened for ESBL-producers and expectant mothers are screened at their first antenatal appointment. To date,\nthere have been no further outbreaks.
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