Outbreaks in the neonatal ICU: a review of the literature
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Published on: August 25, 2014
Julia Johnson1, Caroline Quach
1aDivision of Maternal-Fetal Medicine, Department of Paediatrics, Johns Hopkins University, Baltimore, Maryland, USA bInfection Prevention and Control Unit, Department of Medical Microbiology, CHU Sainte-Justine cDepartment of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montreal, Quebec, Canada.
Insights
Neonatal intensive care unit (NICU) outbreaks are frequently caused by Gram-negative bacteria. Vigilance, comprehensive investigations, and targeted infection control are crucial for preventing and managing these serious neonatal infections.
Area of Science:
- Neonatalogy
- Infectious Diseases
- Public Health
Background:
- Neonates in the neonatal intensive care unit (NICU) are highly susceptible to multidrug-resistant Gram-negative bacteria colonization and infection.
- Such infections are linked to increased morbidity and mortality rates in vulnerable neonates.
Purpose of the Study:
- To review the literature from 2015-2017 regarding outbreaks in NICUs.
- To identify common pathogens, resistance mechanisms, and intervention strategies.
Main Methods:
- Systematic review of English, French, and German literature published between 2015 and 2017.
- Analysis of reported NICU outbreaks, including causative agents and identified sources.
Main Results:
- 39 NICU outbreaks were reported; Gram-negative bacteria caused 54% (n=21), with extended-spectrum beta-lactamase-producing organisms being most frequent.
- Five viral outbreaks were noted, including three of respiratory syncytial virus.
- A third of outbreaks (33%) had an unidentified source; whole genome sequencing was increasingly utilized (n=6).
- Common interventions included hand hygiene education, isolation, contact precautions, and cohorting.
Conclusions:
- NICUs require heightened vigilance for outbreak detection and thorough investigation.
- Targeted infection prevention and control strategies, supported by molecular epidemiology, are essential.
- Further research is needed on the impact of active colonization screening in outbreak management.
Purpose Of Review:
Neonates in the neonatal ICU (NICU) are uniquely vulnerable to colonization and infection with pathogens such as multidrug resistant Gram-negative bacteria, which in turn are associated with increased infection-related morbidities and higher case-fatality rates. We reviewed the English, French, and German language literature published between 2015 and 2017, for reports of NICU outbreaks.
Recent Findings:
A total of 39 outbreaks in NICUs were reported with Gram-negative bacteria (n = 21; 54%) causing most, and extended spectrum beta-lactamase-producing organisms being the most frequent resistance mechanism reported (n = 5). Five viral outbreaks were reported (respiratory syncytial virus = 3). A significant proportion of outbreaks (33%) did not identify a source. Whole genome sequencing was used more (n = 6 reports). The most common described infection prevention and control interventions included staff and parent education on hand hygiene, patient isolation, additional contact precautions, including discontinuation of 'kangaroo care', and cohorting. Reporting and publication bias are likely common.
Summary:
NICUs must be vigilant in identifying outbreaks, conduct comprehensive investigations, and implement targeted infection prevention and control strategies. Molecular epidemiology capacities are an essential element in outbreak investigation. More studies are needed to determine the added value of active colonization screening and their impact on outbreak development.
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