The Increasing Challenge of Multidrug-Resistant Gram-Negative Bacilli

Abstract

Colonization and infection by multidrug-resistant gram-negative bacilli (MDR GNB) in neonatal intensive care units (NICUs) are increasingly reported.We conducted a 5-year prospective cohort surveillance study in a tertiary NICU of the hospital “Paolo Giaccone,” Palermo, Italy. Our objectives were to describe incidence and trends of MDR GNB colonization and the characteristics of the most prevalent organisms and to identify the risk factors for colonization. Demographic, clinical, and microbiological data were prospectively collected. Active surveillance cultures (ASCs) were obtained weekly. Clusters of colonization by extended spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae were analyzed by conventional and molecular epidemiological tools.During the study period, 1152 infants were enrolled in the study. Prevalences of colonization by MDR GNB, ESBL-producing GNB and multiple species/genera averaged, respectively, 28.8%, 11.7%, and 3.7%. Prevalence and incidence density of colonization by MDR GNB and ESBL-producing GNB showed an upward trend through the surveillance period. Rates of ESBL-producing E coli and K pneumoniae colonization showed wide fluctuations peaking over the last 2 years. The only independent variables associated with colonization by MDR GNB and ESBL-producing organisms and multiple colonization were, respectively, the days of NICU stay (odds ratio [OR] 1.041), the days of exposure to ampicillin–sulbactam (OR 1.040), and the days of formula feeding (OR 1.031). Most clusters of E coli and K pneumoniae colonization were associated with different lineages. Ten out of 12 clusters had an outborn infant as their index case.Our study confirms that MDR GNB are an increasing challenge to NICUs. The universal once-a-week approach allowed us to understand the epidemiology of MDR GNB, to timely detect new clones and institute contact precautions, and to assess risk factors. Collection of these data can be an important tool to optimize antimicrobials use and control the emergence and dissemination of resistances in NICU.

Antimicrobial Susceptibility Trends among Pathogens Isolated from Blood: A 6-Year Retrospective Study from a Tertiary Care Hospital in East Sikkim, India

“… 1 2 3 The clinical and epidemiological impact of such antimicrobial resistance (AMR) is a worrisome trend posing severe limitations and challenges to clinicians and health care policymakers alike. 4 5 6…”

An Unsettled Promise: The Newborn Piglet Model of Neonatal Acute Respiratory Distress Syndrome (NARDS). Physiologic Data and Systematic Review

“…The increasing prevalence of colonization by multidrug resistant Gram-negative bacteria, such as E. coli and Klebsiella sp. in neonatal intensive care units (NICU) are correlated with length of NICU stay, and—indeed—exposure to ampicillin/sulbactam (Giuffrè et al, 2016).…”

Can breastfeeding protect against antimicrobial resistance?

“…A cross-sectional study of infants admitted to a hospital in rural Kenya found that current breastfeeding was not protective against gut colonization with ESBL-producing E. coli at the time of admission nor during hospitalization [94]. A 5-year study of infants hospitalized in a neonatal intensive care unit in Italy also found that breastfeeding was not protective against ESBL-producing E. coli acquisition [95]. However, breastfed infants were less likely to become colonized with multidrug-resistant gram-negative bacteria during their stay.…”