Risk factors for colonization with enterococci in a neonatal intensive care unit

Miedema, Carien J.; Kerkhof, Marjan; Arends, Jan P.; Bergman, Klasien A.; Kimpen, Jan L. L.

doi:10.1046/j.1469-0691.2000.00019.x

Cited by 10 publications

(7 citation statements)

References 5 publications

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“…We demonstrated that differences between penicillin and ampicillin are mainly seen in colonization by Gram positive microorganisms. The association between antibiotic use other than amoxicillin and increased enterococcal colonization is well documented in literature [33,36,37]. The results of our study with increased colonization by enterococci in the penicillin compared with the ampicillin arm affirm this.…”

Section: Discussionsupporting

confidence: 87%

Impact of empiric antibiotic regimen on bowel colonization in neonates with suspected early onset sepsis

Parm

Metsvaht

Sepp

et al. 2010

Eur J Clin Microbiol Infect Dis

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HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Abstract The purpose of this study was to compare the impact of ampicillin and penicillin used for empiric treatment of early onset sepsis (EOS) on initial gut colonization by aerobic and facultative anaerobic microorganisms. A cluster-randomized, two-center, switch-over study was conducted in two paediatric intensive care units in Estonia and included 276 neonates. Rectal swabs were collected twice a week until discharge or day 60. Colonizing microbes were identified on species level and tested for ampicillin resistance (AR). The number of patients colonized with Gram negative microorganisms and Candida spp was similar in both treatment arms but ampicillin resulted in longer colonization duration (CD) of K. pneumonia (p=0.012), AR Serratia spp (p=0.012) and Candida spp (p=0.02) and penicillin in that of AR Acinetobacter spp (p=0.001). As for Gram positive microorganisms penicillin treatment was associated with a greater number of colonized patients and higher CD of Enterococcus spp and S. aureus but lower ones of S. haemolyticus and S. hominis. Influence of ampicillin and penicillin on initial gut colonization is somewhat different but these differences are of low clinical relevance and should not be a limiting step when choosing between these two antibiotics for the empiric treatment of EOS.

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Section: Discussionsupporting

confidence: 87%

Impact of empiric antibiotic regimen on bowel colonization in neonates with suspected early onset sepsis

Parm

Metsvaht

Sepp

et al. 2010

Eur J Clin Microbiol Infect Dis

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“…An association between the rate of enterococcal colonization and prematurity has been previously reported in the literature [ 22 ]. In a retrospective case-control study, Miedema et al analyzed risk factors for enterococcal colonization in 579 infants in a neonatal intensive care unit [ 22 ]. Twenty percent of their infants were colonized with enterococci (without further species differentiation) either upon admission to the unit or else during their hospitalization.…”

Section: Discussionmentioning

confidence: 95%

“…Twenty percent of their infants were colonized with enterococci (without further species differentiation) either upon admission to the unit or else during their hospitalization. In a multiple regression analysis, prematurity, days of hospitalization, deep venous line in place, and antibiotics other than amoxicillin were independent risk factors for enterococcal colonization [ 22 ]. Miedema's study cohort did not differentiate between antibiotic-sensitive and drug-resistant enterococci.…”

Section: Discussionmentioning

confidence: 99%

Enterococcal colonization of infants in a neonatal intensive care unit: associated predictors, risk factors and seasonal patterns

et al. 2007

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BackgroundDuring and shortly after birth, newborn infants are colonized with enterococci. This study analyzes predictors for early enterococcal colonization of infants in a neonatal intensive care unit and describes risk factors associated with multidrugresistant enterococci colonization and its seasonal patterns.MethodsOver a 12-month period, we performed a prospective epidemiological study in 274 infants admitted to a neonatal intensive care unit. On the first day of life, we compared infants with enterococcal isolates detected in meconium or body cultures to those without. We then tested the association of enterococcal colonization with peripartal predictors/risk factors by using bivariate and multivariate statistical methods.ResultsTwenty-three percent of the infants were colonized with enterococci. The three most common enterococcal species were E. faecium (48% of isolates), E. casseliflavus (25%) and E. faecalis (13%). Fifty-seven percent of the enterococci found were resistant to three of five antibiotic classes, but no vancomycin-resistant isolates were observed. During winter/spring months, the number of enterococci and multidrug-resistant enterococci were higher than in summer/fall months (p = 0.002 and p < 0.0001, respectively). With respect to enterococcal colonization on the first day of life, predictors were prematurity (p = 0.043) and low birth weight (p = 0.011). With respect to colonization with multidrug-resistant enterococci, risk factors were prematurity (p = 0.0006), low birth weight (p < 0.0001) and prepartal antibiotic treatment (p = 0.019). Using logistic regression, we determined that gestational age was the only parameter significantly correlated with multidrug-resistant enterococci colonization. No infection with enterococci or multidrugresistant enterococci in the infants was detected. The outcome of infants with and without enterococcal colonization was the same with respect to death, necrotizing enterocolitis, intracerebral hemorrhage and bronchopulmonary dysplasia.ConclusionIn neonatal intensive care units, an infant's susceptibility to early colonization with enterococci in general, and his or her risk for colonization with multidrug-resistant enterococci in particular, is increased in preterm newborns, especially during the winter/spring months. The prepartal use of antibiotics with no known activity against enterococci appears to increase the risk for colonization with multidrug-resistant enterococci.

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“…Hufnagel et al reported that prematures( especially premature patients younger than 32 gestational weeks were more likely to be colonized with VRE when compared to mature infants [20] and in another study prematurity was reported as an independent risk factor for VRE colonization [37]. Although prematures formed 44% of our patients in NICU, VRE colonization rates were not higher when compared to mature infants.…”

Section: Discussionmentioning

confidence: 53%

“…Prematurity had been reported as an important risk factor for VRE colonization in NICU [20,37]. Hufnagel et al reported that prematures( especially premature patients younger than 32 gestational weeks were more likely to be colonized with VRE when compared to mature infants [20] and in another study prematurity was reported as an independent risk factor for VRE colonization [37].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for vancomycin-resistant enteroccocci colonization in infants in neonatal intensive care unit

et al. 2010

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AbstractWe aimed to evaluate the risk factors for VRE colonization in neonatal intensive care units. In December 2007, we identified a neonate with VRE infection (urinary tract infection and we performed blood and stool cultures for VRE until the last colonized patient was discharged from our clinic. All the neonates hospitalized in NICU during December 2007 to January 2008. Active surveillance cultures for VRE fecal carriage was carried out in neonatal intensive care unit. Resistance to vancomycin was detected by the E-test method. Epidemiological data was recorded for all patients included in the study and was used for the risk factors. Totally 54 infants in NICU were screened for VRE colonization. Totally 11 infants (20%) were colonized with vancomycin-resistant enterococci. The average duration of all antimicrobial therapy was significantly longer in colonized patients. The infants who were hospitalized for more than 10 days were found to be significantly more colonized with VRE when compared to the infants with shorter hospital stay (p<0.05). There were no statistically significant differences between VRE colonized and non-colonized infants in respect to sex, to third generation cephalosporin usage, glycopeptide usage, presence of prematurity, presence of mechanical ventilation(p> 0.05). The premature infants and the mature infants were under risk of VRE colonization. Longer duration of hospitalization and antimicrobial usage were the prominent risk factors. Since infants in neonatal intensive care units were under risk of infections, periodic active surveillance cultures should be combined with logical antimicrobial therapy.

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Risk factors for colonization with enterococci in a neonatal intensive care unit

Cited by 10 publications

References 5 publications

Impact of empiric antibiotic regimen on bowel colonization in neonates with suspected early onset sepsis

Impact of empiric antibiotic regimen on bowel colonization in neonates with suspected early onset sepsis

Enterococcal colonization of infants in a neonatal intensive care unit: associated predictors, risk factors and seasonal patterns

Risk factors for vancomycin-resistant enteroccocci colonization in infants in neonatal intensive care unit

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