Outbreak of neonatal cellulites and septicemia caused by Salmonella worthington

Infections are responsible for significant mortality and long-term morbidity for infants in the neonatal intensive care unit (NICU). We are reporting an outbreak of neonatal cellulites and sepsis caused by a unique species of Salmonella (Salmonella worthington). We also provide the steps that were initiated in order to control such an unusual epidemic. Our aim is to increase awareness of the community to this rare but serious infection with its unique presentation, and re-emphasize the importance of hand hygiene in the control of infections. This is a retrospective observational study. Data on septicemia and cellulites were collected during January-October 2002 and January-October 2003 in the NICU at Dr. Soetomo hospital. A total of 24 infants with cellulites-septicemia were identified during the period of January-October 2002. Of them 12 cases died. Blood culture of all cases grew S. worthington. All infections occurred during the first 3 days of life. Only one case was identified in the period of January-October 2003; this infant survived. All of the isolates recovered were sensitive to amikacin, chloramphenicol, and meropenem, while resistant to ampicillin. Two third of the cases were sensitive to cefopime 66% Environmental cultures recovered S. worthington from hands of healthcare providers. Outbreaks of S. worthington in NICU have high case-fatality rate, but can be efficiently controlled with hand washing or hand spraying. Cellulites in the newborn are a warning sign for infection with S. worthington.