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Reassessing the need for active surveillance of extended-spectrum beta-lactamase–producing Enterobacteriaceae in the neonatal intensive care population

Published online by Cambridge University Press:  22 October 2018

Xiaoyan Song ,
Lamia Soghier Open the ORCID record for Lamia Soghier [Opens in a new window] ,
Tara Taylor Floyd ,
Tracie R. Harris ,
Billie L. Short Open the ORCID record for Billie L. Short [Opens in a new window]  and
Roberta L. DeBiasi
Xiaoyan Song*
Affiliation:
Children’s National Health System, Washington, DC The George Washington University School of Medicine and Health Sciences, Washington, DC
Lamia Soghier
Affiliation:
Children’s National Health System, Washington, DC The George Washington University School of Medicine and Health Sciences, Washington, DC
Tara Taylor Floyd
Affiliation:
Children’s National Health System, Washington, DC
Tracie R. Harris
Affiliation:
Children’s National Health System, Washington, DC
Billie L. Short
Affiliation:
Children’s National Health System, Washington, DC The George Washington University School of Medicine and Health Sciences, Washington, DC
Roberta L. DeBiasi
Affiliation:
Children’s National Health System, Washington, DC The George Washington University School of Medicine and Health Sciences, Washington, DC
*
Author for correspondence: Xiaoyan Song, Children’s National Health System, West Wing 3.5 Suite 100, 111 Michigan Ave NW, Washington, DC 20010. E-mail: xsong@cnmc.org
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Abstract

Objective

To determine the continued need for active surveillance to prevent extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-E) transmission in a neonatal intensive care unit (NICU).

Design

This retrospective observational study included patients with ESBL-E colonization or infection identified during their NICU stay at our institution between 1999 and March 2018. Active surveillance was conducted between 1999 and March 2017 by testing rectal swab specimens collected upon admission and weekly thereafter. The overall incidence rates, of ESBL-E colonization or infection (including hospital acquired) before and after active surveillance were calculated. The cost associated with active surveillance was then estimated.

Results

Overall, 171 NICU patients were found to have ESBL-E colonization or infection, and 150 of those patients (87.7%) were detected by active surveillance. The overall incidence rate was 1.4 per 100 patient admissions. The hospital-acquired incidence rate was 0.41 per 1,000 patient days, and this rate had decreased since 2002, with an average of 6 cases detected annually. A significant decrease was observed in 2009 when the unit moved to a new single-bed unit featuring private rooms. Active surveillance was discontinued with no increase in the number of infections. Of the 150 ESBL-E colonized patients, 14 (9.3%) subsequently developed an infection. Active surveillance resulted in a total of 50,950 specimen collections and a cost of $127,187 for processing, an average of $848 to detect 1 ESBL-E colonized patient.

Conclusion

ESBL-E transmission and infection in our NICU remains uncommon. Active surveillance may have contributed to the decline of ESBL-E transmission when used in conjunction with contact precautions and private rooms, but its relatively high cost could be prohibitive.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 12 , December 2018 , pp. 1436 - 1441
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Song X, et al. (2018). Reassessing the need for active surveillance of extended-spectrum beta-lactamase–producing Enterobacteriaceae in the neonatal intensive care population. Infection Control & Hospital Epidemiology 2018, 39, 1436–1441. doi: 10.1017/ice.2018.260

References

1. Bradford, PA . Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 2001;14:933–951.Google Scholar
2. Ben-Ami, R , Schwaber, MJ , Navon-Venezia, S , et al. Influx of extended-spectrum beta-lactamase-producing enterobacteriaceae into the hospital. Clin Infect Dis 2006;42:925–934.Google Scholar
3. Rodriguez-Bano, J , Navarro, MD , Romero, L , et al. Epidemiology and clinical features of infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in nonhospitalized patients. J Clin Microbiol 2004;42:1089–1094.Google Scholar
4. Fedler, KA , Biedenbach, DJ , Jones, RN . Assessment of pathogen frequency and resistance patterns among pediatric patient isolates: report from the 2004 SENTRY Antimicrobial Surveillance Program on three continents. Diagn Microbiol Infect Dis 2006;56:427–436.Google Scholar
5. Gales, AC , Castanheira, M , Jones, RN , Sader, HS . Antimicrobial resistance among gram-negative bacilli isolated from Latin America: results from SENTRY Antimicrobial Surveillance Program (Latin America, 2008–2010). Diagn Microbiol Infect Dis 2012;73:354–360.Google Scholar
6. Goossens, H , Grabein, B . Prevalence and antimicrobial susceptibility data for extended-spectrum beta-lactamase– and AmpC-producing Enterobacteriaceae from the MYSTIC program in Europe and the United States (1997–2004). Diagn Microbiol Infect Dis 2005;53:257–264.Google Scholar
7. Badal, RE , Bouchillon, SK , Lob, SH , Hackel, MA , Hawser, SP , Hoban, DJ . Etiology, extended-spectrum beta-lactamase rates and antimicrobial susceptibility of gram-negative bacilli causing intra-abdominal infections in patients in general pediatric and pediatric intensive care units—global data from the Study for Monitoring Antimicrobial Resistance Trends, 2008 to 2010. Pediatr Infect Dis J 2013;32:636–640.Google Scholar
8. Gupta, A , Della-Latta, P , Todd, B , et al. Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails. Infect Control Hosp Epidemiol 2004;25:210–215.Google Scholar
9. Cotton, MF , Wasserman, E , Pieper, CH , et al. Invasive disease due to extended spectrum beta-lactamase–producing Klebsiella pneumoniae in a neonatal unit: the possible role of cockroaches. J Hosp Infect 2000;44:13–17.Google Scholar
10. Crivaro, V , Bagattini, M , Salza, MF , et al. Risk factors for extended-spectrum beta-lactamase–producing Serratia marcescens and Klebsiella pneumoniae acquisition in a neonatal intensive care unit. J Hosp Infect 2007;67:135–141.Google Scholar
11. Shakil, S , Akram, M , Ali, SM , Khan, AU . Acquisition of extended-spectrum beta-lactamase–producing Escherichia coli strains in male and female infants admitted to a neonatal intensive care unit: molecular epidemiology and analysis of risk factors. J Med Microbiol 2010;59:948–954.Google Scholar
12. Cosgrove, SE . The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42 Suppl 2: S82–S89.Google Scholar
13. Schwaber, MJ , Carmeli, Y . Mortality and delay in effective therapy associated with extended-spectrum beta-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother 2007;60:913–920.Google Scholar
14. Schwaber, MJ , Navon-Venezia, S , Kaye, KS , Ben-Ami, R , Schwartz, D , Carmeli, Y . Clinical and economic impact of bacteremia with extended- spectrum-beta-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother 2006;50:1257–1262.Google Scholar
15. Martins, IS , Moreira, BM , Riley, LW , Santoro-Lopes, G . Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infection among renal transplant recipients. J Hosp Infect 2006;64:305–308.Google Scholar
16. Reddy, P , Malczynski, M , Obias, A , et al. Screening for extended-spectrum beta-lactamase–producing Enterobacteriaceae among high-risk patients and rates of subsequent bacteremia. Clin Infect Dis 2007;45:846–852.Google Scholar
17. Wilson, AP , Livermore, DM , Otter, JA , et al. Prevention and control of multi-drug-resistant Gram-negative bacteria: recommendations from a Joint Working Party. J Hosp Infect 2016;92 Suppl 1:S1–S44.Google Scholar
18. Blot, S , Depuydt, P , Vandijck, D , Vandewoude, K , Peleman, R , Vogelaers, D. Predictive value of surveillance cultures and subsequent bacteremia with extended-spectrum beta-lactamase-producing Enterobacteriaceae. Clin Infect Dis 2008;46:481–482; author reply 482.Google Scholar
19. Singh, N , Leger, MM , Campbell, J , Short, B , Campos, JM. Control of vancomycin-resistant enterococci in the neonatal intensive care unit. Infect Control Hosp Epidemiol 2005;26:646–649.Google Scholar
20. Song, X , Cheung, S , Klontz, K , Short, B , Campos, J , Singh, N. A stepwise approach to control an outbreak and ongoing transmission of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Am J Infect Control 2010;38:607–611.Google Scholar
21. Mathers, AJ , Poulter, M , Dirks, D , Carroll, J , Sifri, CD , Hazen, KC. Clinical microbiology costs for methods of active surveillance for Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Infect Control Hosp Epidemiol 2014;35:350–355.Google Scholar
22. Arhoune, B , Oumokhtar, B , Hmami, F , et al. Rectal carriage of extended-spectrum beta-lactamase– and carbapenemase-producing Enterobacteriaceae among hospitalised neonates in a neonatal intensive care unit in Fez, Morocco. J Glob Antimicrob Resist 2017;8:90–96.Google Scholar
23. Benenson, S , Levin, PD , Block, C , et al. Continuous surveillance to reduce extended-spectrum beta-lactamase Klebsiella pneumoniae colonization in the neonatal intensive care unit. Neonatology 2013;103:155–160.Google Scholar
24. Harris, AD , McGregor, JC , Johnson, JA , et al. Risk factors for colonization with extended-spectrum beta-lactamase–producing bacteria and intensive care unit admission. Emerg Infect Dis 2007;13:1144–1149.Google Scholar
25. Verhoef, J , Beaujean, D , Blok, H , et al. A Dutch approach to methicillin-resistant Staphylococcus aureus . Eur J Clin Microbiol Infect Dis 1999;18:461–466.Google Scholar
26. Ostrowsky, BE , Trick, WE , Sohn, AH , et al. Control of vancomycin-resistant Enterococcus in health care facilities in a region. N Engl J Med 2001;344:1427–1433.Google Scholar
27. Marshall, C , Richards, M , McBryde, E. Do active surveillance and contact precautions reduce MRSA acquisition? A prospective interrupted time series. PLoS One 2013;8:e58112.Google Scholar
28. Evans, ME , Kralovic, SM , Simbartl, LA , Jain, R , Roselle, GA. Eight years of decreased methicillin-resistant Staphylococcus aureus healthcare-associated infections associated with a Veterans Affairs prevention initiative. Am J Infect Control 2017;45:13–16.Google Scholar
29. Siegel, JD , Rhinehart, E , Jackson, M , Chiarello, L , Healthcare Infection Control Practices Advisory C. Management of multidrug-resistant organisms in healthcare settings, 2006. Am J Infect Control 2007;35:S165–S193.Google Scholar
30. Rybczynska, H , Melander, E , Johansson, H , Lundberg, F. Efficacy of a once-a-week screening programme to control extended-spectrum beta-lactamase–producing bacteria in a neonatal intensive care unit. Scand J Infect Dis 2014;46:426–432.Google Scholar