Is It Possible to Foresee the Risk Factors for Carbapenem-Resistant Gram-Negative Bacterial Colonization in Newborns?

Area of Science:

• Neonatal Intensive Care Unit (NICU) infections
• Antimicrobial resistance
• Infection control in healthcare settings

Background:

• Carbapenem-resistant gram-negative bacteria (CR-GNB) pose a significant threat in NICUs, leading to high morbidity and mortality.
• Early identification of modifiable risk factors for CR-GNB rectal colonization is crucial for effective prevention strategies.
• Limited therapeutic options necessitate a focus on infection control and risk factor mitigation.

Purpose of the Study:

• To determine the risk factors associated with CR-GNB rectal colonization in hospitalized infants.
• To define the prevalence, clinical impact, and temporal trends of CR-GNB colonization in a tertiary NICU.
• To identify independent risk factors for CR-GNB colonization through multivariate analysis.

Main Methods:

• Retrospective evaluation of 112 infants with CR-GNB colonization and 113 controls from January 2017 to 2020.
• Routine weekly rectal swab surveillance for CR-GNB colonization initiated within 24 hours of NICU admission.
• Univariate and multivariate logistic regression analyses to identify independent risk factors.

Main Results:

• Colonization was associated with male sex, prolonged hospitalization, mechanical ventilation, perinatal hypoxia, colostomy, intraventricular hemorrhage, bronchopulmonary dysplasia, indwelling catheters, total parenteral nutrition, orogastric (OG) tube, antibiotic exposure, and formula feeding.
• Healthcare-associated infections were more prevalent in the colonized group.
• Multivariate analysis identified OG tube use, male sex, and antibiotic use as independent risk factors for CR-GNB colonization.

Conclusions:

• Prioritizing modifiable factors like OG tube use, broad-spectrum antibiotic exposure, and formula feeding in NICU protocols can reduce CR-GNB colonization.
• Recognizing these risk factors and vigilant monitoring of infection indicators are essential for improving neonatal outcomes.
• Targeted interventions focusing on identified risk factors are key to combating CR-GNB spread in NICUs.