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Neonates younger than 7 days have low colonization rates of resistant organisms
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Colonization rate of antimicrobial resistant organisms at transfer is low in infants aged younger than 7 days, according to recent study findings.
“Infections with antibiotic-resistant organisms are associated with substantial morbidity and mortality among infants hospitalized in the neonatal intensive care unit and increase the length of hospitalization and health care costs,” Theodore Macnow, MD, and colleagues wrote in a study published in The Pediatric Infectious Disease Journal. “The incidence of [antimicrobial-resistant organisms] infections in neonates has increased over the past 2 decades, limiting potential treatment options. Identification of potential reservoirs of [antimicrobial-resistant organisms] in the [neonatal intensive care unit] and use of appropriate infection control strategies could prevent patient-to-patient transmission.”
The retrospective study included 1,751 infants in two level III neonatal ICUs from 2004 to 2010. Cultures were evaluated for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and antibiotic-resistant gram-negative rods.
Researchers found the rates of MRSA, VRE and antibiotic-resistant gram-negative rods were 3%, 1.7% and 1%, respectively. Participants transferred to the neonatal ICU aged older than 7 days had 5.8 increased odds of antimicrobial-resistant organism colonization compared with those aged younger than 7 days. Participants who were colonized had similar rates of mortality, antimicrobial-resistant organism infection, and duration of hospitalization compared with those who were not colonized. Cost of the laboratory surveillance cultures during the study period was $58,425.
“We suggest that a safe and more effective strategy would be to culture infants who are 7 days of age or older at the time of transfer,” researchers wrote. “Future multicenter studies should assess the relative safety of this strategy by monitoring infections with [antimicrobial-resistant organisms]. The results of this study could subsequently inform the development of more cost-effective surveillance policies that target infants at higher risk for [antimicrobial-resistant organism] colonization.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Allison H. Bartlett, MD, MS
Protecting our most vulnerable patients from infection with antibiotic resistant organisms (AROs) is an important component of hospital infection control practices. The goal of surveillance is early identification and isolation of colonized infants in hopes of preventing patient-to-patient transmission of AROs and subsequent invasive infection. Macnow et al analyzed the impact of a practice of routine surveillance cultures for all patients transferred to either of two NICUs.
The authors found that the overall rate of colonization with an ARO was 5.2%. The only significant predictor of ARO colonization was age at the time of transfer: the rate in infants ≥ 7 days old (10.2%) was much higher than the rate in infants <7 days old (1.2%). The risk of developing an ARO infection was the same for colonized and uncolonized infants. The overwhelming majority of infections in colonized infants were not caused by their colonizing organisms; instead, they represent probable nosocomial acquisition. The study results suggest focusing surveillance efforts on high-risk infants (≥ 7 days old) could be effective and cost-saving; the authors caution that monitoring the rate of ARO infections following implementation would be important to confirm the safety of a targeted screening approach.
Surveillance is expensive: laboratory fees, contact isolation supplies (gowns, gloves), employee time and effort. There are additional non-monetary costs of isolation including less-frequent interactions between staff and patients and psychosocial effects on the family. Knowledge of the local ARO prevalence in both inborn and outborn infants can help inform policy decisions. Development of institution-specific surveillance policies that target populations at high risk for ARO colonization and transmission may help conserve our finite healthcare resources. Ultimately, however, the information provided by a surveillance program is only as useful as the institution’s ability to encourage and enforce the use of contact precautions.
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