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Published on: February 17, 2023
Carbapenemase-Producing Enterobacteriaceae (CPE) Newborn Colonization in a Portuguese Neonatal Intensive Care Unit
Teresa L Almeida1,2, Tânia Mendo1,3, Raquel Costa1,2
1Neonatal Intensive Care Unit, Centro Hospitalar Lisboa Ocidental, Department of Pediatrics, Hospital de São Francisco Xavier, 1449-005 Lisboa, Portugal.
Insights
Carbapenemase-producing Enterobacterales (CPE) colonization affects 5.8% of neonates in a NICU. Identified risk factors include low birth weight and central line use, though independent factors remain unclear. Active surveillance is key to control.
Area of Science:
- Medical Microbiology
- Neonatal Intensive Care
- Infectious Disease Epidemiology
Background:
- Carbapenemase-producing Enterobacterales (CPE) infections are a growing global threat, particularly in neonatal intensive care units (NICUs).
- Understanding risk factors for CPE gut colonization in neonates is crucial for effective prevention strategies.
Purpose of the Study:
- To describe the epidemiological and clinical features of CPE-colonized newborns in a Portuguese NICU.
- To identify risk factors associated with CPE colonization in the neonatal population.
- To evaluate the effectiveness of infection control measures in managing CPE colonization.
Main Methods:
- Prospective, observational, longitudinal cohort study for CPE colonization surveillance.
- Data collection included maternal and neonatal features, and surveillance strategies.
- Statistical analysis using SPSS23.0, including bivariate and logistic regression analyses.
Main Results:
- CPE was isolated in 5.8% of 173 neonates admitted between March and November 2019.
- Carbapenemase-producing Klebsiella pneumoniae was the most frequent isolate; no associated infections were reported.
- Bivariate analysis identified birth weight, gestational age, length of stay, and central line duration as risk factors; logistic regression found no independent factors.
Conclusions:
- Accurate CPE colonization risk factors in neonates require further investigation.
- Active surveillance and robust infection control measures were effective in containing a CPE colonization cluster and preventing outbreaks.
- Continued vigilance and implementation of control strategies are essential in NICUs to combat CPE spread.
Abstract:
Infections due to carbapenemase-producing Enterobacterales (CPE) are increasing worldwide and are especially concerning in a neonatal intensive care unit (NICU). Risk factors for CPE gut colonization in neonates need to be clarified. In this work, we describe the epidemiological and clinical features of CPE-colonized newborns and the infection control measures in a Portuguese NICU. We performed a prospective, observational, longitudinal, cohort study for surveillance of CPE colonization. Maternal and neonatal features of colonized newborns and surveillance strategy were described. A statistical analysis was performed with SPSS23.0, and significance was indicated by p-value ≤ 0.05. Between March and November 2019, CPE was isolated in 5.8% of 173 admitted neonates. Carbapenemase-producing Klebsiella pneumoniae were the most frequently isolated. There was no associated infection. Birth weight, gestational age, length of stay, and days of central line were the identified risk factors for CPE colonization (bivariate analysis with Student's t-test or Mann-Whitney U test, according to normality). No independent risk factors for CPE colonization were identified in the logistic regression analysis. CPE colonization risk factors are still to be determined accurately in the neonatal population. Active surveillance and continuous infection control measures restrained the current cluster of colonized newborns and helped to prevent infection and future outbreaks.
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