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[Diarrhea outbreak and bacterial resistance to ampicillin in newborns]
Abstract:
Twenty-eight healthy neonates from the San Juan de Dios Hospital were studied to determine the pattern of antibiotic resistance of indigenous intestinal bacteria. Sixty-eight per cent of infants had enterobacteriaceae resistant to several wide-spectrum antibiotics, including ampicillin; 28 per cent of the cultures had plasmid-mediated ampicillin resistance. In the course of the study, an outbreak of 10 acute cases of diarrhea occurred, not associated to any of the commonly known agents, including the rotaviruses. Enterobacteriaceae multiple resistant were isolated from all cases; ampicillin-resistant strains were found in all; those resistances were mediated by transmissible plasmids. Several sites of the Neonatology Ward were sampled and two yielded E. coli with resistance to 8 drugs transmissible in vitro. The outbreak was controlled after strict hygienic measures were established in the ward. A following sample showed a decrease in indigenous antibiotic-resistant strains, especially E. coli; however, plasmid mediated resistant Klebsiella was still isolated several months later. The need to regulate the use of antibiotics; to educate the medical personnel and the public in general and to modify the hospital norms and regulations are discussed in the paper.
Insights
Antibiotic resistance in infant gut bacteria is a significant concern. This study found widespread resistance, including during a diarrhea outbreak, highlighting the need for better antibiotic stewardship and hospital hygiene.
Area of Science:
- Microbiology
- Neonatal Health
- Infectious Diseases
Background:
- Antibiotic resistance in indigenous intestinal bacteria of neonates is a growing public health concern.
- Previous studies indicate varying levels of resistance, necessitating ongoing surveillance.
Purpose of the Study:
- To determine the antibiotic resistance patterns of indigenous intestinal bacteria in healthy neonates.
- To investigate the role of antibiotic resistance in a neonatal ward diarrhea outbreak.
Main Methods:
- Culturing and antibiotic susceptibility testing of intestinal bacteria from 28 healthy neonates.
- Environmental sampling of the Neonatology Ward during a diarrhea outbreak.
- Plasmid analysis to identify the mechanisms of antibiotic resistance.
Main Results:
- 68% of neonates harbored Enterobacteriaceae resistant to multiple broad-spectrum antibiotics, including ampicillin.
- 28% of cultures showed plasmid-mediated ampicillin resistance.
- A diarrhea outbreak was linked to multidrug-resistant Enterobacteriaceae with transmissible plasmids; resistant E. coli strains were isolated from ward sites.
Conclusions:
- Widespread antibiotic resistance exists in neonatal intestinal flora, often plasmid-mediated.
- Strict hygienic measures are crucial for controlling outbreaks of resistant bacteria in hospital settings.
- Regulation of antibiotic use, medical education, and revised hospital protocols are essential to combat antibiotic resistance.