Epidemic Nosocomial Meningitis Due to Citrobacter diversus in Neonates

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Abstract
Five infants born at 1 hospital over a 2 yr period developed meningitis due to a serotype O2 strain of C. diversus; 4 infants developed brain abscesses due to this organism. The initial prevalence of stool colonization in infants was 79%; eventually 140 infants (10%) and 7 nurses (6%) were found to be colonized. One colonized infant remained in the hospital for the entire 2 yr period. The strains were of 2 biotypes marked by the presence (biotype d) or absence (biotype a) of fermentation of sucrose qnd dulcitol. The biotyped strain was found in the 5 infants with meningitis, 110 asymptomatic infants and 5 nurses. The biotype a strain, which was isolated from 30 infants and 1 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). A fecal reservoir and person-to-person transmission of C. diversus were suggested. Measures to control the outbreak cost about $110,000.