Prevention of nosocomial infections and surveillance of emerging resistances in NICU

Abstract

Neonates hospitalized in NICU are at risk for healthcare associated infections because of their poor immune defenses, related to gestational age, colonization of mucous membranes and skin with nosocomial microorganisms, exposure to antibiotics, invasive procedures and frequent contacts with healthcare workers (HCWs). Healthcare associated infections are the major source of morbidity and mortality in NICU in the developed world. Most infections are caused by Gram-positive organisms, fulminant sepsis are often associated to Gram-negative organisms, fungal sepsis occurs frequently in ELBW infants. Hand hygiene is the most important preventive procedure, nevertheless hand hygiene compliance among HCWs remains low. Continuous educational strategies can improve hand hygiene and contribute to reducing the incidence of neonatal infections. Other important prevention strategies include early enteral feeding with human milk, minimization and safety in the use of invasive devices, limiting unnecessary empiric broadspectrum antibiotics, eventual use of lactoferrin bifidobacteria and lactobacilli, prophylactic administration of fluconazole in VLBW. Emergence of multi drug resistant organisms (MDRO) is a worrying perspective. Methicillin-resistant Staphylococcus aureus (MRSA) is an important healthcare-associated pathogen. Active surveillance culturing for MRSA carriers, in combination with contact precautions and decolonization in some hyperendemic settings, has been proved to reduce MRSA transmission and infection rates. Multidrug-resistant Gram-negatives are frequently reported. Overuse of antimicrobial drugs and crosstransmission via caregiver hands, contaminated equipment or inanimate objects are the major drivers of selection and dissemination. Strategies to control outbreaks of MDRO colonization/infection in the NICU may include performing hand hygiene, cohorting and isolating patients, screening healthcare workers and performing admission and periodic surveillance cultures.

Time-series analysis of the relationship of antimicrobial use and hand hygiene promotion with the incidence of healthcare-associated infections

“…Time-series analysis in conjunction with a broadly applied a stewardship program. 12,16 appears to be a powerful clinical tool for the analysis and prediction of infectious diseases and has potential to help reduce the incidence of HAIs and HA-MRSA infections.…”

“…Previous research has identified numerous risk factors for HA-MRSA, including prolonged hospital stay, exposure to broadspectrum antibiotics and exposure to a greater number of antimicrobials. 11,12 Lucet et al 13 reported that the factors associated with MRSA in the ICU were older than 60 years, prolonged hospital stay, history of hospitalization or surgery and presence of open skin lesions in directly admitted patients. Antimicrobial use and infection control measures have important roles in the prevention of HAIs, 14 but the need for a policy of active surveillance is controversial.…”

“…19 Studies of the effect of reducing antimicrobial use on the incidence of antimicrobial resistance have yielded various results. 12,14,20 In 1990, Mouton et al 21 reported a correlation of methicillin resistance in coagulase-negative staphylococci and use of (flu)cloxacillin, cephalosporins and gentamicin. Other studies have reported correlations in use of antimicrobials and development of resistance in S. aureus.…”

“…15,17 Previous studies have reported that most HAIs are transmitted via transient contamination of HCWs hands. 12,18 Thus, use of effective hand-hygiene practices, surveillance cultures and contact precautions have become major measures for infection control and prevention of MRSA. 19 Studies of the effect of reducing antimicrobial use on the incidence of antimicrobial resistance have yielded various results.…”

Risk factors for carbapenem-resistant Acinetobacter baumanii blood stream infections in a neonatal intensive care unit, Delhi, India

“…Early feeding with human milk has been considered to be an important prevention strategy for nosocomial infections in NICUs [24]. A study on beta-lactam-resistant aerobic commensal fecal flora of newborns showed that feeding with tube feed was protective during the hospital stay and that failure to feed with breast milk was a risk factor for colonization with extended-spectrum beta-lactamaseproducing bacteria after discharge [25].…”