Colonization with antimicrobial-resistant Gram-negative bacilli at neonatal intensive care unit discharge

Sarah A. Clock, Yu Hui Ferng, Setareh Tabibi, Luis Alba, Sameer J. Patel, Haomiao Jia, Patricia DeLaMora, Jeffrey M. Perlman, David A. Paul, Theoklis Zaoutis, Elaine L. Larson, Lisa Saiman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Background. The epidemiology of the colonization of infants with antimicrobial-resistant Gram-negative bacilli (GNB) at discharge from the neonatal intensive care unit (NICU) is not well understood. Methods. A multicenter study in which rectal surveillance samples for culture were obtained at NICU discharge from infants hospitalized ≥ 14 days was performed. Factors associated with colonization with GNB resistant to gentamicin, third/fourth-generation cephalosporin agents, or carbapenem agents were assessed by using a fixed-effects model. Results. Of these infants, 9% (119 of 1320) were colonized with ≥ 1 antimicrobial-resistant GNB. Prolonged treatment (≥ 10 days) with meropenem or third/fourth-generation cephalosporin agents or treatment for ≥5 days with a β-lactam/β-lactamase combination agent were associated with an increased risk of colonization with GNB resistant to gentamicin. Surgery and ≥ 5 days of treatment with third/fourth-generation cephalosporin agents, a β-lactam/β-lactamase combination agent, or metronidazole were associated with an increased risk of colonization with GNB resistant to third/fourth-generation cephalosporin agents. Female sex and prolonged treatment (≥ 10 days) with meropenem were associated with colonization with GNB resistant to carbapenem agents. Conclusions. Prolonged treatment with broad-spectrum antibiotics was associated with the colonization of infants with antimicrobial- resistant GNB within 7 days of NICU discharge. These findings suggest the potential for dissemination of resistant GNB from colonized infants to other NICUs, the community, or pediatric long-term care facilities. Antimicrobial stewardship efforts aimed at improving appropriate antibiotic use could have a beneficial effect on the emergence of antimicrobial-resistant GNB in the NICU population.

Original languageEnglish (US)
Pages (from-to)219-226
Number of pages8
JournalJournal of the Pediatric Infectious Diseases Society
Volume6
Issue number3
DOIs
StatePublished - Sep 1 2017

Keywords

  • Antimicrobial resistance
  • Cephalosporin agents
  • Gentamicin
  • Meropenem
  • Risk factors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Infectious Diseases

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