Transmission of Neonatal Listeriosis in a Delivery Room

Two cases of neonatal listeriosis occurred In a hospital within a two-week period. Both infants were infected with the same organism, Listeria monocytogenes, type 1a, bacteriophage type 6 (lysotype 1652). Both infants were born in the same delivery room, 17 hours apart. The index patient became septic shortly after birth and died after 48 hours despite antibiotic therapy. The mother of the index patient was febrile and had chorioamnionitis. The second infant became ill with meningitis at 13 days of age. Neither infants nor mothers were attended by the same medical or nursing staff nor were they in the same labor or postpartum areas or nurseries. However, both infants were resuscitated in the same delivery room after birth by means of laryngoscope, suction catheter, and emergency resuscitation (Ambu) bag. Although it was hospital policy to clean and sterilize resuscitation equipment after use, the equipment had only been wiped with alcohol between patients in this instance, since sterile replacement equipment was not available during the early-morning hours when the index birth occurred. Therefore, we believe the contaminated resuscitation equipment was the source of infection in the second infant. This episode emphasizes the importance of appropriate disinfection of respiratory resuscitation equipment to prevent nosocomial infection due to L monocytogenes, an unusual but important pathogen in neonates.