Articles
Reduction in colonization and nosocomial infection by multiresistant bacteria in a neonatal unit after institution of educational measures and restriction in the use of cephalosporins*

https://doi.org/10.1067/mic.2001.114223Get rights and content

Abstract

Introduction: Previous administration of third-generation cephalosporins predisposes to colonization and infections by multiresistant Enterobacter sp. The emergence of multiresistant bacteria infections in a neonatal unit during 1995, especially Enterobacter cloacae , stimulated this study. Objective: To evaluate the efficacy of measures to control colonization and nosocomial infection by multiresistant bacteria in a neonatal unit. Setting: A tertiary care university hospital. Patients and Methods: This study was conducted from October 1995 through December 1999 in 4 phases: a cross-sectional study, a longitudinal study with intervention measures, monthly cross-sectional studies, and determination of nosocomial infections caused by multiresistant bacteria (oxacillin-resistant Staphylococcus aureus and gram-negative bacteria resistant to either aminoglycosides or third-generation cephalosporins). Specimens for surveillance culture were obtained through umbilical and rectal swabs, and tracheal aspirates from intubated babies. The intervention measures were as follows: (1) appropriated training of the whole health care team, emphasizing measures to reduce cross-colonization, and the importance of rational usage of antibiotics and (2) suppression of usage of third-generation cephalosporins. Risk factors were analyzed through univariate and multivariate logistic regression. Results: In the first phase, 32% (10/31) of the patients were colonized by multiresistant bacteria (29% by multiresistant E cloacae ). In the second phase, 342 patients were evaluated; 33% of them were colonized by E cloacae, and a multiresistant strain was isolated in 10.8% (37/342) of the babies. A logistic regression model indicated parenteral nutrition and antibiotic usage as risk factors for colonization by multiresistant E cloacae. In the third phase, for 6 months, only 2 patients were colonized by multiresistant E cloacae. In the fourth phase, the analysis of bacterial resistance profile indicated a reduction of nosocomial infections due to multiresistant bacteria from 18 cases in 1995 to 2 cases per year until 1999. Conclusion: These results have shown that the measures adopted were effective. (Am J Infect Control 2001;29:133-8)

Section snippets

Patients and Methods

In 1995 the neonatal unit consisted of 30 beds, divided into 8 intensive care beds (2 wards of 4 beds) and 22 intermediate care beds. This nursery is located in a teaching hospital, and it serves as a reference to a region with 3 million inhabitants. The number of births in the last 5 years averaged 3152 a year, being 17.3% of low–birth-weight and 4.1% of very-low–birth-weight babies. The number of admissions to the high-risk nursery was approximately 600 babies a year.

An infection control

Results

During the first phase of the study, 67 samples from 31 patients were cultured (31 rectal swabs, 31 umbilical swabs, and 5 tracheal aspirates). The positivity of the cultures was 71.6% (83.9% of the rectal swabs, 58% of the umbilical swabs, 80% of the tracheal aspirates). In 16.1% of the patients, no bacteria were isolated. Among 26 patients, 50 bacterial strains were isolated. Gram-negative strains represented 72% of the positive cultures. E cloacae was isolated in 45.2% (14/31) of the

Discussion

The first part of the study served as a motivating tool to the neonatal unit staff. This was an important goal to be achieved because by that time, almost half of the patients admitted to the unit were colonized byE cloacae , two thirds of which were multiresistant.

Considering that 93% of the E cloacae strains were sensitive to amikacin, this drug was chosen to replace ceftriaxone and gentamicin (to whom respectively 35.7% and 50% of the strains were sensitive) as one of the first-line drugs to

Acknowledgements

We thank Joaquim Murray Bustorff Silva, MD, for the review of this article.

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    Reprint requests: Roseli Calil, MD, Rua Major Luciano Teixeira, N° 31, Edificio Cedro, Apto 103, Bairro Bonfim, Campinas—SP—Brazil CEP 13070-460.

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