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Enterobacteriaceae infections of very low birth weight infants in Polish neonatal intensive care units: resistance and cross-transmission.
Pediatr Infect Dis J. 2013 Jun; 32(6):594-8.PI

Abstract

BACKGROUND

The aims of our study were analysis of the occurrence of infections by members of the Enterobacteriaceae family in 6 Polish neonatal intensive care units in 2009, their drug resistance, the epidemiology of extended-spectrum β-lactamase (ESBL)-producing strains and the possibility of using modern tools of microbiology diagnosis in infection control, especially for the reduction of antimicrobial resistance.

METHODS

A prospective surveillance covered 910 newborns. Case patients were defined as neonates with very low birth weight who had clinical signs of septicemia, pneumonia or necrotizing enterocolitis. Early-onset infection was defined as infection diagnosed within 3 days after delivery.

RESULTS

The incidence of Enterobacteriaceae infections was 2.6/1000 patient-days. The risk of Enterobacteriaceae pneumonia increased with the length of hospitalization (P = 0.0356). The most common pathogen was Escherichia coli (12.4% of all strains, in early-onset infection 18.5%) and Klebsiella spp. (9.1% of all). The ESBL phenotype was found in 37% of isolates, of which 89.3% were producing CTX-M-type, 70.2% TEM-type and 8.5% SHV-type. Epidemic clones were detected in the 2 studied neonatal intensive care units: 6 of the 9 ESBL-positive Enterobacter cloacae and 16 of the 18 ESBL-positive Klebsiella pneumoniae strains were classified into 1 epidemic clone, which showed resistance to penicillin without inhibitors, amoxycillin/clavulanic acid, cephalosporins, aztreoname, aminoglycosides and trimethoprim/sulfamethoxazole.

CONCLUSIONS

Enterobacteriaceae bacilli are a significant problem in neonatal intensive care units, especially in early-onset infection and for long hospitalized very low birth weight infants. The observed high drug resistance was in large part related to the dominance of epidemic strains as a result of horizontal transmission. The best way to reduce drug resistance would be adequate procedures of isolation and hand hygiene.

Authors+Show Affiliations

Microbiology, Jagiellonian University Medical College, Krakow, Poland. mbmach@cyf-kr.edu.plNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23411624

Citation

Wójkowska-Mach, Jadwiga, et al. "Enterobacteriaceae Infections of Very Low Birth Weight Infants in Polish Neonatal Intensive Care Units: Resistance and Cross-transmission." The Pediatric Infectious Disease Journal, vol. 32, no. 6, 2013, pp. 594-8.
Wójkowska-Mach J, Chmielarczyk A, Borszewska-Kornacka M, et al. Enterobacteriaceae infections of very low birth weight infants in Polish neonatal intensive care units: resistance and cross-transmission. Pediatr Infect Dis J. 2013;32(6):594-8.
Wójkowska-Mach, J., Chmielarczyk, A., Borszewska-Kornacka, M., Domańska, J., Gadzinowski, J., Gulczyńska, E., Nowiczewski, M., Helwich, E., Kordek, A., Pawlik, D., Jursa-Kulesza, J., Giedrys-Kalemba, S., Szczapa, J., & Heczko, P. B. (2013). Enterobacteriaceae infections of very low birth weight infants in Polish neonatal intensive care units: resistance and cross-transmission. The Pediatric Infectious Disease Journal, 32(6), 594-8. https://doi.org/10.1097/INF.0b013e318287fe2a
Wójkowska-Mach J, et al. Enterobacteriaceae Infections of Very Low Birth Weight Infants in Polish Neonatal Intensive Care Units: Resistance and Cross-transmission. Pediatr Infect Dis J. 2013;32(6):594-8. PubMed PMID: 23411624.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Enterobacteriaceae infections of very low birth weight infants in Polish neonatal intensive care units: resistance and cross-transmission. AU - Wójkowska-Mach,Jadwiga, AU - Chmielarczyk,Agnieszka, AU - Borszewska-Kornacka,Maria, AU - Domańska,Joanna, AU - Gadzinowski,Janusz, AU - Gulczyńska,Ewa, AU - Nowiczewski,Marek, AU - Helwich,Ewa, AU - Kordek,Agnieszka, AU - Pawlik,Dorota, AU - Jursa-Kulesza,Joanna, AU - Giedrys-Kalemba,Stefania, AU - Szczapa,Jerzy, AU - Heczko,Piotr B, PY - 2013/2/16/entrez PY - 2013/2/16/pubmed PY - 2014/2/7/medline SP - 594 EP - 8 JF - The Pediatric infectious disease journal JO - Pediatr. Infect. Dis. J. VL - 32 IS - 6 N2 - BACKGROUND: The aims of our study were analysis of the occurrence of infections by members of the Enterobacteriaceae family in 6 Polish neonatal intensive care units in 2009, their drug resistance, the epidemiology of extended-spectrum β-lactamase (ESBL)-producing strains and the possibility of using modern tools of microbiology diagnosis in infection control, especially for the reduction of antimicrobial resistance. METHODS: A prospective surveillance covered 910 newborns. Case patients were defined as neonates with very low birth weight who had clinical signs of septicemia, pneumonia or necrotizing enterocolitis. Early-onset infection was defined as infection diagnosed within 3 days after delivery. RESULTS: The incidence of Enterobacteriaceae infections was 2.6/1000 patient-days. The risk of Enterobacteriaceae pneumonia increased with the length of hospitalization (P = 0.0356). The most common pathogen was Escherichia coli (12.4% of all strains, in early-onset infection 18.5%) and Klebsiella spp. (9.1% of all). The ESBL phenotype was found in 37% of isolates, of which 89.3% were producing CTX-M-type, 70.2% TEM-type and 8.5% SHV-type. Epidemic clones were detected in the 2 studied neonatal intensive care units: 6 of the 9 ESBL-positive Enterobacter cloacae and 16 of the 18 ESBL-positive Klebsiella pneumoniae strains were classified into 1 epidemic clone, which showed resistance to penicillin without inhibitors, amoxycillin/clavulanic acid, cephalosporins, aztreoname, aminoglycosides and trimethoprim/sulfamethoxazole. CONCLUSIONS: Enterobacteriaceae bacilli are a significant problem in neonatal intensive care units, especially in early-onset infection and for long hospitalized very low birth weight infants. The observed high drug resistance was in large part related to the dominance of epidemic strains as a result of horizontal transmission. The best way to reduce drug resistance would be adequate procedures of isolation and hand hygiene. SN - 1532-0987 UR - https://www.unboundmedicine.com/medline/citation/23411624/Enterobacteriaceae_infections_of_very_low_birth_weight_infants_in_Polish_neonatal_intensive_care_units:_resistance_and_cross_transmission_ L2 - http://dx.doi.org/10.1097/INF.0b013e318287fe2a DB - PRIME DP - Unbound Medicine ER -