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Objective: We describe the first outbreak of multiple drug-resistant Acinetobacter baumannii (MDR-Ab) in a neonatal intensive care unit in the United States., Design/methods: MDR-Ab was identified in the blood of a 24-week gestation, 7-day-old extremely low birth weight neonate. Multiple samplings of surveillance surface cultures were performed on exposed and nonexposed neonates. Enhanced infection control measures were implemented. Pulsed-field gel electrophoresis was performed to determine the genetic relatedness of the MDR-Ab isolates. Medical records were reviewed for all exposed patients., Results: MDR-Ab was recovered from 6 additional neonates. Of these 7 MDR-Ab (index + 6) neonates, 4 died, 3 of whom had positive blood cultures. All affected neonates were born between 23 to 26 weeks gestational age, and were <7 days postnatal age and <750 g (430-720) at the time of exposure. All were housed within the same room as the index case. None of the other 5 exposed neonates older than postnatal day 7 or weighing >750 g at birth were affected. No additional cases occurred outside the original room. Pulsed-field gel electrophoresis was consistent with a clonal origin, identical to MDR-Ab recovered from the referring hospital., Conclusions: This MDR-Ab outbreak was rapidly controlled with enhanced infection control measures and was novel in that it affected only <750 g neonates, at < or =26 weeks gestational age, and < or =7 days postnatal age at the time of exposure, suggesting that invasive Ab has a special affinity for damaged or nonkeratinized immature skin in developmentally immature immunologic hosts.

Background: Respiratory syncytial virus (RSV) is the most common respiratory pathogen in infancy and childhood., Objective: To compare the compliance and biologic efficacy of a home health care agency dosing-compliance program to treatment provided in a physician's office setting during a single RSV season (November to May). METHODS.: AAP guidelines were used to identify neonates who were eligible for RSV prophylaxis before discharge from a neonatal intensive care unit setting. Parents were asked to choose to receive the recommended treatment for their child either in their pediatrician's office setting or through a sequence of periodic nursing visits to their home. All home health care records were reviewed for demographics, number of doses received and hospitalization rate. Pediatricians office records were surveyed by telephone interview of their office staff and parents. Compliance data were calculated based on actual monthly injections given during the RSV season., Results: We followed prospectively 1446 infants who received palivizumab during a single RSV season (November 1, 2000 through April 30, 2001). Of these infants 67% (969 of 1446) received their monthly injections in the home setting where 98% of the doses were given on schedule. In contrast 477 infants (33%) received their injections in a pediatrician's office (parent's choice) with a compliance of only 89% for completion of all recommended doses (P < 0.001 vs. home setting). There were 9 RSV hospitalizations (0.93%) in the home setting group and 8 RSV hospitalizations (3.57%) in the office setting (P < 0.001). More parents indicated that the in-home prophylaxis program was more convenient than was true for those receiving treatment in the physician's office setting (P < 0.01)., Conclusions: Better compliance with home injections was associated with a decrease in the hospitalization rate for RSV with a higher degree of parental satisfaction.