Related Experiment Videos
A nursery outbreak of multiple-aminoglycoside-resistant Escherichia coli
Abstract:
In the neonatal intensive care unit (NICU) of one hospital, 16 infants became colonized or infected with multiply-resistant Escherichia coli (MR-E.coli) over an 8-month period. Isolates were obtained from blood, urine, and sputum of three patients and from rectal surveillance cultures of 13 patients. The one patient with the blood isolate died. A matched case-control study identified continuous feeding (nine of 16 cases vs. one of 16 controls, p less than or equal to 0.001) and receipt of aminoglycosides (p less than or equal to 0.03) as risk factors. For case-babies not exposed to continuous feeding, duration of bolus feeding was significantly greater than for their controls (cases, 22 days; controls, 7 days; p less than or equal to 0.02). All 16 isolates were the same serotype and were resistant to amikacin, tobramycin, kanamycin, and gentamicin. The epidemiologic investigation suggested that MR-E. coli may have spread from person-to-person on the hands of personnel and that MR-E. coli persisted in the NICU for 8 months until effective control measures were instituted.
Insights
Multiply-resistant Escherichia coli (MR-E. coli) outbreaks in neonatal intensive care units (NICUs) are linked to continuous feeding and aminoglycoside use. Effective control measures are crucial to prevent MR-E. coli spread.
Area of Science:
- Neonatal Intensive Care Unit (NICU) Infections
- Antimicrobial Resistance
- Epidemiology
Background:
- Multiply-resistant Escherichia coli (MR-E. coli) poses a significant threat in healthcare settings.
- Neonatal intensive care units (NICUs) are particularly vulnerable to outbreaks due to the delicate health of infants.
Purpose of the Study:
- To investigate an outbreak of MR-E. coli colonization and infection in a hospital's NICU.
- To identify risk factors associated with MR-E. coli acquisition in neonates.
- To understand the transmission dynamics and persistence of MR-E. coli within the NICU.
Main Methods:
- A matched case-control study was conducted.
- Infants were monitored through rectal surveillance cultures, and isolates were obtained from blood, urine, and sputum.
- Epidemiologic investigation included analysis of feeding methods and antibiotic exposure.
Main Results:
- Sixteen infants were colonized or infected with the same serotype of MR-E. coli over an 8-month period.
- Continuous feeding (p ≤ 0.001) and aminoglycoside receipt (p ≤ 0.03) were identified as significant risk factors.
- Prolonged duration of bolus feeding was observed in cases compared to controls (22 days vs. 7 days, p ≤ 0.02).
- One patient with a blood isolate died.
Conclusions:
- Continuous feeding and aminoglycoside use are associated with increased risk of MR-E. coli acquisition in NICU infants.
- Person-to-person transmission via healthcare personnel hands is a suspected route of spread.
- Effective control measures are necessary to eradicate MR-E. coli from the NICU environment.