| Title | High frequency of multidrug-resistant gram-negative rods in 2 neonatal intensive care units in the Philippines. | | Author(s) | Litzow JM, Gill CJ, Mantaring JB, Fox MP, MacLeod WB, Mendoza M, Mendoza S, Scobie R, Huskins CW, Goldman DA, Hamer DH | | Institution | Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA. | | Source | Infect Control Hosp Epidemiol 2009 Jun; 30(6):543-9. | | MeSH | Anti-Bacterial Agents
Bacteremia
Carrier State
Drug Resistance, Multiple, Bacterial
Female
Gram-Negative Bacteria
Gram-Negative Bacterial Infections
Humans
Infant, Extremely Low Birth Weight
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases
Intensive Care Units, Neonatal
Male
Microbial Sensitivity Tests
Philippines
Risk Factors
| | Abstract | BACKGROUND: Although hospital-acquired infections appear to be a growing threat to the survival of newborns in the developing world, the epidemiology of this problem remains poorly characterized.
METHODS: During a 10-month period, we conducted prospective longitudinal surveillance for colonization and bloodstream infection caused by gram-negative rods among all infants hospitalized in the 2 largest neonatal intensive care units in Manila, the Philippines. We determined antibiotic susceptibilities and calculated adjusted odds ratios for risk factors for bacteremia by means of multivariate logistic regression.
RESULTS: Of 1,831 neonates enrolled during a 10-month period, 1,017 (55.5%) became newly colonized and 358 (19.6%) became bacteremic with a drug-resistant gram-negative rod, most commonly Klebsiella species, Enterobacter species, Acinetobacter species, and Pseudomonas aeruginosa. Of the invasive isolates, 20% were resistant to imipenem, 41% to trimethoprim-sulfamethoxazole, 52% to amikacin, 63% to ampicillin-sulbactam, 67% to ceftazidime, and 80% to tobramycin. The factors significantly associated with an increased risk of bacteremia were mechanical ventilation and prematurity. Additionally, colonization with a drug-resistant gram-negative rod was an independent risk factor for bacteremia (odds ratio, 1.4 [95% confidence interval, 1.0-1.9]).
CONCLUSIONS: Colonization with a drug-resistant gram-negative rod was an independent risk factor for sepsis. If our data are typical, the unusually high intensity of colonization pressure and disease caused by multidrug-resistant gram-negative rods at these 2 neonatal intensive care units indicates an emerging healthcare crisis in the developing world. Improved infection control methods are therefore critically needed in developing countries. | | Language | eng | | Pub Type(s) | Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
| | PubMed ID | 19435448 |
|
