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

Carbapenem-resistant gram-negative bacteria (CR-GNB) have become a critical concern in neonatal intensive care units (NICUs) due to limited therapeutic options, high morbidity, and mortality. Early identification of modifiable risk factors for rectal colonization is essential to guide infection control and preventive strategies. This study aimed to determine the risk factors associated with CR-GNB rectal colonization in hospitalized infants and to define the prevalence, clinical impact, and temporal trends of colonization in a tertiary NICU.

A total of 112 infants with rectal CR-GNB colonization and 113 non-colonized infants were retrospectively evaluated between January 2017 and 2020. Colonized patients were identified through routine weekly rectal swab surveillance initiated within the first 24 hours of NICU admission. Controls were matched for gestational age and approximate date of birth and received similar NICU care, although unmeasured factors related to caregivers and environment may exist. Demographic, perinatal, clinical, microbiological, and treatment data were retrospectively collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors.

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

Identifying and addressing modifiable factors such as orogastric tube use, broad spectrum antibiotic exposure, and formula feeding should be prioritized in preventive NICU protocols to reduce CR-GNB colonization. Recognition of these risk factors and careful monitoring of infection indicators may improve neonatal outcomes.