Document Detail

Surveillance of multidrug-resistant gram-negative bacilli in a neonatal intensive care unit: prominent role of cross transmission.
MedLine Citation:
PMID:  17482993     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Multidrug-resistant gram-negative bacilli (MDRGN) are an important cause of nosocomial infections in neonatal intensive care units (NICUs). We conducted a 1-year prospective surveillance study in an NICU to assess the epidemiology of MDRGN among newborns and the relative importance of acquisition routes. METHODS: Neonates admitted at the NICU of the Dipartimento Materno-Infantile, University Hospital, Palermo, Italy, from January 7, 2003, to January 6, 2004, were included in the study. Colonization of patients with MDRGN was assessed by cultures of rectal swabs sampled twice a week. Pulsed-field gel electrophoresis was used to determine relatedness among MDRGN isolates. Extended-spectrum beta-lactamases (ESBL) and metallo-beta-lactamases (MBL) production was investigated. The association between risk factors at admission and during the NICU stay was analyzed by multivariate logistic regression analysis. RESULTS: During the 12-month period January 7, 2003, through January 6, 2004, 1021 rectal swabs were cultured from 210 infants. One hundred sixteen infants (55.2%) were colonized by MDRGN. The monthly incidence of acquisition of MDRGN ranged between 12 and 53 cases per 1000 patient-days. Eighty-four (72.4%) of the 116 patients were cross colonized. Exclusive feeding by formula was significantly associated with cross transmission (RR=1.8, P=.02). Fifty-seven (49.1%) of the 116 infants were colonized by ESBL-producing Enterobacteriaceae. Feeding by formula was significantly associated with colonization by ESBL-producing Enterobacteriaceae (RR=1.6, P=.007), whereas breastfeeding proved to be protective (RR=0.5, P=.001). Ninety-two (43.8%) of the 210 infants received antibiotics during the NICU stay, but exposure to those most frequently administered, ampicillin-sulbactam and gentamicin, was not significantly associated with MDRGN colonization. CONCLUSION: The emerging picture of this study is that spread of MDRGN in an NICU may be the result of diffuse cross transmission and, consequently, of poor infection control procedures.
Caterina Mammina; Paola Di Carlo; Domenico Cipolla; Mario Giuffrè; Alessandra Casuccio; Vincenzo Di Gaetano; Maria Rosa Anna Plano; Emma D'Angelo; Lucina Titone; Giovanni Corsello
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of infection control     Volume:  35     ISSN:  0196-6553     ISO Abbreviation:  Am J Infect Control     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-05-07     Completed Date:  2007-06-26     Revised Date:  2009-08-14    
Medline Journal Info:
Nlm Unique ID:  8004854     Medline TA:  Am J Infect Control     Country:  United States    
Other Details:
Languages:  eng     Pagination:  222-30     Citation Subset:  IM    
Dipartimento di Igiene e Microbiologia G. D'Alessandro, Università degli Studi, Palermo, Italy.
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MeSH Terms
Cross Infection / epidemiology,  microbiology*,  transmission
Drug Resistance, Multiple*
Electrophoresis, Gel, Pulsed-Field
Enterobacteriaceae / classification,  drug effects*
Gram-Negative Bacterial Infections / drug therapy,  epidemiology*,  transmission
Infant, Newborn
Infection Control
Intensive Care Units, Neonatal*
Italy / epidemiology
Microbial Sensitivity Tests
Prospective Studies
Sentinel Surveillance

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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