Related Experiment Video
Updated: Mar 21, 2026
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Neonates at a risk of hospital-acquired ESKAPEE infection despite implementation of infection prevention protocols
L Heine1, A Sibisi2, R H Van Wyk2
1Water and Health Research Centre, University of Johannesburg, Johannesburg, Gauteng, South Africa.
Insights
Multidrug-resistant bacteria, including ESKAPEE pathogens, were prevalent in a South African NICU during the COVID-19 pandemic. Enhanced infection control measures are crucial to mitigate the significant infection risk posed by these resistant bacteria.
Area of Science:
- Microbiology
- Infectious Diseases
- Public Health
Background:
- Healthcare-associated infections (HAIs) are a significant concern, often linked to antimicrobial resistance (AMR).
- AMR in HAIs leads to worse patient outcomes, increased transmission, and higher healthcare costs.
- The COVID-19 pandemic may have altered the landscape of bacterial infections in healthcare settings.
Purpose of the Study:
- To assess the infection risk posed by ESKAPEE pathogens and other bacteria in a neonatal intensive care unit (NICU) during the COVID-19 pandemic.
- To identify and characterize antimicrobial resistance patterns of bacterial isolates from a NICU in Gauteng, South Africa.
Main Methods:
- Collection of 420 surface and handwash samples from a NICU between July and November 2020.
- Isolation and identification of 238 bacterial isolates using culture-based methods and the VITEK 2® compact system.
- Confirmation of bacterial identification via species- or genus-specific polymerase chain reaction and antimicrobial susceptibility testing.
Main Results:
- Over 32% of samples yielded bacterial growth, with 238 isolates identified.
- A high prevalence of multidrug-resistant (MDR) bacteria was observed: 92.1% of Gram-positive cocci and 66.7% of Gram-negative bacilli were MDR.
- ESKAPEE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species, Escherichia coli) comprised 28 isolates, with over 85% identified as MDR.
Conclusions:
- The presence of MDR bacteria, including ESKAPEE pathogens, in the NICU presents a substantial infection risk.
- Existing infection prevention and control strategies in South African hospitals require strengthening.
- Regular monitoring and assessment of implementation and staff adherence to infection control measures are essential.
Background:
Healthcare associated infections are frequently reported to be antimicrobial resistant. This resistance contributes to poorer patient outcomes, increases the spread of infection and an increase the financial burden on healthcare systems.
Aim:
In an effort to assess whether ESKAPEE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species and Escherichia coli) and other bacteria posed an infection risk during the COVID-19 pandemic, 420 surface swabs and handwash samples were collected from a neonatal intensive care unit (NICU) at a public hospital in Gauteng, South Africa, from July to November 2020.
Methods:
Sterile cotton swabs and sterile, sealable sampling bags were used to collect samples, surface swabs and handwash samples. Bacteria isolated (N = 238) from 127 (32.2%) of the total 420 samples via culture-based methods were then identified using the VITEK 2® compact system. Identifications were confirmed by species- or genus-specific polymerase chain reaction.
Findings:
bacterial isolates were also subjected to antimicrobial susceptibility testing using the VITEK 2® compact system and then categorized as multi-drug-resistant (MDR) or extensively drug resistant (XDR). Almost all (35/38, 92.1%) of the Gram-positive cocci analysed were categorized as MDR. Two-thirds (22/33, 66.7%) of the Gram-negative bacilli analysed were categorized as MDR, and one was XDR. ESKAPEE pathogens (N = 28), including Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species, comprised a subset of isolated bacteria. Over 85% (24/28) of the ESKAPEE pathogens were identified as MDR.
Conclusion:
The presence of these MDR bacteria in the NICU poses an important infection risk, and as such, existing infection prevention and control measures in this and other South African hospitals should be strengthened and their implementation and staff adherence to these measures should be regularly monitored and/or assessed.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....