1338 High Proportion of Intestinal ESBL Colonization Among Infants at a Neonatal Intensive Care Unit in a Tertiary Hospital in Ecuador

Abstract

Abstractswith increased morbidity and mortality. No data are available on neonatal colonization with ESBL-producing bacteria in Ecuador. The study aimed to assess the proportion of intestinal colonization with ESBL-producing Enterobacteriacae and their resistance pattern among infants hospitalized at the neonatal intensive care unit, Cuenca, Ecuador. Methods From February to April 2011, stool specimens were collected, every two weeks, from all hospitalized neonates. Rectal swabs were plated on Mac Conkey agar containing cefotaxime and ceftazidime. Species identification and susceptibility tests were confirmed with Vitek2 and the epidemiologic typing was performed using Diversilab (Both bioMérieux). Results 137 specimens were collected from 78 patients and 61.5% of the neonates became colonized with ESBL. The majority of the strains were Escherichia coli (EC, 88.5%) followed by Klebsiella pneumoniae (KP, 11.5%). Gentamicin resistance occurred in 98.6% of the EC and 100% of the KP and ciprofloxacin resistance in 98.6% of the EC and 0% of the KP strains. All strains were susceptible to carbapenems. Epidemiologic typing divided the EC isolates in two clusters and one unique isolate and the KP isolates were divided in two clusters. All EC and KP had bla CTX-M group 1 except for the unique EC isolate that had bla CTX-M group 9. Conclusions The high proportion of patients colonized with four clones of ESBL-producing bacteria, reinforces the necessity for implementing surveillance programs as well as improved infection control to prevent further spread of ESBL strains between hospitalized neonates. Background Both clinical findings and the high incidence of decidual inflammation/infection in placentasare associated with preterm deliveries. Objectives To find out the relation of histopathology and microbiology findings of the placenta and preterm birth and to document the association of placental changes and neonatal outcome. Methods and results A comparative, analytical study was carried out on Placentas from 100 mothers, 50 with preterm delivery (case group), and 50 with full term delivery(control group). Pathology of the placentas and PCR to detect bacterial SrDNA were performed for the placentae and neonates. Preterm Placentas showed a significantly higher inflammatory lesions than those of full term placentas, (68% in preterm versus 4% in full term). The percentage of bacterial isolation by PCR from preterm placenta was significantly higher than full term placenta (75% vs 22%), suggesting that most of unexplained preterm delivery is inflammation and/or infection related. The study demonstrated significant association between placental and neonatal bacterialSrDNA. Our results showed that placental inflammatory lesions were significantly associated with lower gestational age, lower weight and length of preterm neonates. On follow up of the preterm neonates, the percentage of RDS, SGA, BPD and neonatal mortality rate were higher among preterm with placental inflammation/infection than those without. Conclusion Infectio...