1. Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program
- Author
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Carmelo Massimo Maida, Francesco Vitale, Aurora Aleo, Vincenzo Insinga, Grazia Rinaudo, Mario Giuffrè, Celestino Bonura, Emanuele Amodio, Vitaliti M, Giovanni Corsello, Giorgio Graziano, Federica Mescolo, Laura Saporito, Saporito L., Graziano G., Mescolo F., Amodio E., Insinga V., Rinaudo G., Aleo A., Bonura C., Vitaliti M., Corsello G., Vitale F., Maida C.M., and Giuffre M.
- Subjects
0301 basic medicine ,Microbiology (medical) ,Male ,medicine.medical_specialty ,Neonatal intensive care unit ,030106 microbiology ,Extended spectrum β lactamases producing klebsiella pneumoniae ,Context (language use) ,Drug resistance ,Microbial Sensitivity Tests ,Antimicrobial resistance ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,0302 clinical medicine ,Antibiotic resistance ,Medical microbiology ,Internal medicine ,Drug Resistance, Multiple, Bacterial ,Intensive Care Units, Neonatal ,Gram-Negative Bacteria ,medicine ,Humans ,Pharmacology (medical) ,lcsh:RC109-216 ,030212 general & internal medicine ,Cross Infection ,Infection Control ,Active surveillance program ,business.industry ,Research ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,Antimicrobial ,Multi-drug resistant gram-negative bacteria ,Electrophoresis, Gel, Pulsed-Field ,Infectious Diseases ,Carriage ,Italy ,Intervention strategy ,Carrier State ,Female ,Sample collection ,business ,Gram-Negative Bacterial Infections - Abstract
BackgroundAntimicrobial resistance in neonatal intensive care unit (NICU) patients is a threat, due to the frequent use of antimicrobial treatment and invasive devices in fragile babies. Since 2014 an active surveillance program of multidrug-resistant Gram-negative bacteria (MDR-GNB) carriage has been in place in the five NICUs of Palermo, Italy. In 2017 an increase in the prevalence of MDR-GNB, and in particular of extended-spectrum β-lactamases-producingKlebsiella pneumoniae(ESBL-KP), was observed in “Civico” hospital NICU.AimTo assess the impact of a coordinated intervention strategy in achieving long-lasting reduction of MDR-GNB prevalence in the NICU.MethodsRectal swabs were obtained monthly and processed to detect MDR-GNB using standard methods. MDR-GNB were characterized by pulsed-field gel electrophoresis (PFGE). Since November 2017 the following intervention measures were applied: (a) two-months intensification of sample collection; (b) stakeholders meetings; (c) improvement of prevention measures and antimicrobial policies.FindingsDuring the intensified microbiological surveillance MDR-GNB and ESBL-KP were detected in rectal swabs (34.8%; 23.2%), nasal swabs (24.6%; 14.5%), oral swabs (14.5%; 5.4%), milk samples (32.1%; 17.9%), pacifiers swabs (30.8%; 17.9%) and from sub-intensive room surfaces. Thirteen ESBL-KP strains isolated from clinical and environmental samples showed identical PFGE patterns. The prevalence of MDR-GNB and ESBL-KP carriage significantly decreased in the year after intervention compared to the previous year (20.6% vs 62.2%;p p p ConclusionsMDR-GNB broadly circulate in NICU setting, they can colonize different body sites and spread through various vehicles. A coordinated strategy of multiple interventions with active cooperation between epidemiologists and clinicians in the NICU can effectively reduce their circulation and in particular the carriage of the most dangerous ESBL-KP strains.
- Published
- 2021