Issue: August 2013
July 17, 2013
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Neonates younger than 7 days have low colonization rates of resistant organisms

Issue: August 2013
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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.

Perspective from Allison H. Bartlett, MD, MS

“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.