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Laura Saporito
University of Palermo, Italy
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9756-0957
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Background: Antimicrobial resistance in Neonatal Intensive Care Unit (NICU) patients is a threat, due to the large 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 is 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-producing Klebsiella pneumoniae (ESBL-KP) was observed in “Civico” hospital NICU.
Aim: To estimate the impact of a coordinated intervention strategy in achieving long-lasting reduction of MDR-GNB prevalence in the NICU.
Methods: Rectal swabs were obtained monthly and processed to detect MDR-GNB using standard methods. MDR-GNB were characterized by pulsed-field gel electrophoresis (PFGE). From November 2017 the following intervention measures were applied: a) two-months strengthening of sample collection; b) stakeholders’ meetings; c) improvement of prevention measures and antimicrobial policy.
Prevalence of MDR-GNB carriage observed in the 12 months before and in the 24 months after intervention were compared by chi-square test. Risk factors for MDR-GNB carriage in a subgroup of patients were identified by a multivariate logistic regression model.
Findings: During the strengthened 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%), soother swabs (30.8%; 17.9%) and from a sub-intensive room surface. Thirteen ESBL-KP strains isolated from clinical and environmental samples showed identical PFGE patterns. ESBL-KP was detected no more until June 2018. No MDR-GNB isolate was detected for three months.
Prevalence of MDR-GNB and ESBL-KP carriage after intervention significantly decreased compared to the previous year (20.6% vs 62.2 %; p<0.001 and 11.1% vs 57.8%; p<0.001). Multivariate analysis of principal exposure variables showed that admission in post-intervention period significantly reduced the risk of MDR-GNB carriage (OR=0.15, p=0.01).
Conclusions: MDR-GNB broadly circulate in NICU setting and can colonize different body sites and spread by 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 most dangerous ESBL-KP strains.
Keywords
antimicrobial resistance, active surveillance program, multi-drug resistant Gram-negative bacteria, intervention strategy, extended spectrum β lactamases producing Klebsiella pneumoniae, neonatal intensive care unit
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CURRENT STATUS: Published
View the published article at Antimicrobial Resistance & Infection Control.
No community comments so far
Editorial decision: Accept
On 20 Jan, 2021
Editor assigned
On 18 Jan, 2021
Submission checks complete
On 18 Jan, 2021
Editor invited
On 18 Jan, 2021
No comments provided
Editorial decision: Minor revision
On 27 Dec, 2020
Review #2 received
Received 25 Dec, 2020
Review #1 received
Received 09 Nov, 2020
Reviewer #2 agreed
On 02 Nov, 2020
Reviewers invited
Invitations sent on 02 Nov, 2020
Reviewer #1 agreed
On 02 Nov, 2020
Editor assigned
On 29 Oct, 2020
Submission checks complete
On 28 Oct, 2020
Editor invited
On 28 Oct, 2020
Version 1
Posted 03 Jun, 2020
No comments provided
Editorial decision: Major revision
On 12 Aug, 2020
Reviewer #5 agreed
On 06 Aug, 2020
Reviewer #4 agreed
On 31 Jul, 2020
Reviewer #3 agreed
On 26 Jul, 2020
Review #2 received
Received 12 Jul, 2020
Review #1 received
Received 12 Jul, 2020
Reviewer #2 agreed
On 29 Jun, 2020
Reviewer #1 agreed
On 19 Jun, 2020
Reviewers invited
Invitations sent on 19 Jun, 2020
Editor assigned
On 16 Jun, 2020
Editor invited
On 15 Jun, 2020
Submission checks complete
On 29 May, 2020
First submitted
On 28 May, 2020
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A new preprint design is coming!
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See the published version of this preprint at Antimicrobial Resistance & Infection Control.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Laura Saporito
University of Palermo, Italy
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9756-0957
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Antimicrobial Resistance & Infection Control.
No community comments so far
Editorial decision: Accept
On 20 Jan, 2021
Editor assigned
On 18 Jan, 2021
Submission checks complete
On 18 Jan, 2021
Editor invited
On 18 Jan, 2021
No comments provided
Editorial decision: Minor revision
On 27 Dec, 2020
Review #2 received
Received 25 Dec, 2020
Review #1 received
Received 09 Nov, 2020
Reviewer #2 agreed
On 02 Nov, 2020
Reviewers invited
Invitations sent on 02 Nov, 2020
Reviewer #1 agreed
On 02 Nov, 2020
Editor assigned
On 29 Oct, 2020
Submission checks complete
On 28 Oct, 2020
Editor invited
On 28 Oct, 2020
Version 1
Posted 03 Jun, 2020
No comments provided
Editorial decision: Major revision
On 12 Aug, 2020
Reviewer #5 agreed
On 06 Aug, 2020
Reviewer #4 agreed
On 31 Jul, 2020
Reviewer #3 agreed
On 26 Jul, 2020
Review #2 received
Received 12 Jul, 2020
Review #1 received
Received 12 Jul, 2020
Reviewer #2 agreed
On 29 Jun, 2020
Reviewer #1 agreed
On 19 Jun, 2020
Reviewers invited
Invitations sent on 19 Jun, 2020
Editor assigned
On 16 Jun, 2020
Editor invited
On 15 Jun, 2020
Submission checks complete
On 29 May, 2020
First submitted
On 28 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Antimicrobial Resistance & Infection Control.
Background: Antimicrobial resistance in Neonatal Intensive Care Unit (NICU) patients is a threat, due to the large 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 is 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-producing Klebsiella pneumoniae (ESBL-KP) was observed in “Civico” hospital NICU.
Aim: To estimate the impact of a coordinated intervention strategy in achieving long-lasting reduction of MDR-GNB prevalence in the NICU.
Methods: Rectal swabs were obtained monthly and processed to detect MDR-GNB using standard methods. MDR-GNB were characterized by pulsed-field gel electrophoresis (PFGE). From November 2017 the following intervention measures were applied: a) two-months strengthening of sample collection; b) stakeholders’ meetings; c) improvement of prevention measures and antimicrobial policy.
Prevalence of MDR-GNB carriage observed in the 12 months before and in the 24 months after intervention were compared by chi-square test. Risk factors for MDR-GNB carriage in a subgroup of patients were identified by a multivariate logistic regression model.
Findings: During the strengthened 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%), soother swabs (30.8%; 17.9%) and from a sub-intensive room surface. Thirteen ESBL-KP strains isolated from clinical and environmental samples showed identical PFGE patterns. ESBL-KP was detected no more until June 2018. No MDR-GNB isolate was detected for three months.
Prevalence of MDR-GNB and ESBL-KP carriage after intervention significantly decreased compared to the previous year (20.6% vs 62.2 %; p<0.001 and 11.1% vs 57.8%; p<0.001). Multivariate analysis of principal exposure variables showed that admission in post-intervention period significantly reduced the risk of MDR-GNB carriage (OR=0.15, p=0.01).
Conclusions: MDR-GNB broadly circulate in NICU setting and can colonize different body sites and spread by 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 most dangerous ESBL-KP strains.
Figure 1
Figure 2
Figure 3
Figure 4
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