| Surveillance of multidrug-resistant gram-negative bacilli in a neonatal intensive care unit: prominent role of cross transmission. | |
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MedLine Citation:
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PMID: 17482993 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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Title: American journal of infection control Volume: 35 ISSN: 0196-6553 ISO Abbreviation: Am J Infect Control Publication Date: 2007 May |
Date Detail:
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Created Date: 2007-05-07 Completed Date: 2007-06-26 Revised Date: 2009-08-14 |
Medline Journal Info:
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Nlm Unique ID: 8004854 Medline TA: Am J Infect Control Country: United States |
Other Details:
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Languages: eng Pagination: 222-30 Citation Subset: IM |
Affiliation:
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Dipartimento di Igiene e Microbiologia G. D'Alessandro, Università degli Studi, Palermo, Italy. diptigmi@unipa.it |
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| MeSH Terms | |
Descriptor/Qualifier:
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Cross Infection
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epidemiology,
microbiology*,
transmission Drug Resistance, Multiple* Electrophoresis, Gel, Pulsed-Field Enterobacteriaceae / classification, drug effects* Female Gram-Negative Bacterial Infections / drug therapy, epidemiology*, transmission Humans Infant, Newborn Infection Control Intensive Care Units, Neonatal* Italy / epidemiology Male Microbial Sensitivity Tests Prospective Studies Sentinel Surveillance |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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