Cargando…

Surveillance for Antimicrobial-resistant Organisms in Infants Transferred to the Neonatal Intensive Care Unit: Trends in Colonization and Practices

BACKGROUND: Infections with antibiotic-resistant organisms (AROs), i.e., methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multi-drug-resistant Gram-negative rods (MDR-GNR) among infants hospitalized in the Neonatal Intensive Care Unit (NICU) are associa...

Descripción completa

Detalles Bibliográficos
Autores principales: Duchon, Jennifer, Maykowski, Philip, Good, Pamela, Kytomaa, Sonja, DeLaMora, Patricia, Saiman, Lisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5631502/
http://dx.doi.org/10.1093/ofid/ofx163.1833
_version_ 1783269488971481088
author Duchon, Jennifer
Maykowski, Philip
Good, Pamela
Kytomaa, Sonja
DeLaMora, Patricia
Saiman, Lisa
author_facet Duchon, Jennifer
Maykowski, Philip
Good, Pamela
Kytomaa, Sonja
DeLaMora, Patricia
Saiman, Lisa
author_sort Duchon, Jennifer
collection PubMed
description BACKGROUND: Infections with antibiotic-resistant organisms (AROs), i.e., methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multi-drug-resistant Gram-negative rods (MDR-GNR) among infants hospitalized in the Neonatal Intensive Care Unit (NICU) are associated with mortality and serious morbidities. Implementing appropriate infection control policies may help prevent transmission of AROs. However, the most effective strategies for surveillance of AROs in the NICU are unclear. Prior data collected from infants transferred from outside hospitals to 2 NICUs affiliated with New York-Presbyterian (NYP) Hospital detected low rates of ARO colonization in the first week of life. Thus, in 2013 the strategy of performing surveillance on all transferred infants for AROs was changed to performing targeted surveillance on infants transferred at >7 days of life (DOL). The purpose of this study was to assess this change in surveillance strategy and monitor ARO colonization trends in the NICU. METHODS: Data from all infants transported to the NICUs at NYP from 2007 to 2016 were used. Risk factors for colonization with AROs including demographics and admitting diagnoses were explored using a multivariable binomial mixed model clustered by transferring hospital and controlled for NYP NICU. Trends in ARO colonization over time were assessed using negative binomial regression. Site 1 elected not to adopt the change in surveillance policy, and thus was used as a control. RESULTS: From 2007 to 2016, 2925 infants were transferred to the NYP NICUs, 1101 at Site 1 and 1824 at Site 2; 2571 (88%) had surveillance for at least 1 ARO. There were 226 positive surveillance cultures in 204 infants (8%): 94 (3.7%) for MRSA, 78 (3%) for VRE and 54 (2%) for MDR-GNR. In the final models, transfer DOL remained a highly significant (OR per day = 1.018, CI(95) 1.014, 1.022, P < 0.001) predictor of colonization with any ARO. There was no significant increase in the incidence of transferred infants colonized with AROs over time in either NICU; this remained true in infants who were < 7 days of life at Site 1. CONCLUSION: These data continue to support the rationale for our change in surveillance policy. Further studies should evaluate the effect of this strategy on ARO transmission in the general NICU population. DISCLOSURES: All authors: No reported disclosures.
format Online
Article
Text
id pubmed-5631502
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-56315022017-11-07 Surveillance for Antimicrobial-resistant Organisms in Infants Transferred to the Neonatal Intensive Care Unit: Trends in Colonization and Practices Duchon, Jennifer Maykowski, Philip Good, Pamela Kytomaa, Sonja DeLaMora, Patricia Saiman, Lisa Open Forum Infect Dis Abstracts BACKGROUND: Infections with antibiotic-resistant organisms (AROs), i.e., methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multi-drug-resistant Gram-negative rods (MDR-GNR) among infants hospitalized in the Neonatal Intensive Care Unit (NICU) are associated with mortality and serious morbidities. Implementing appropriate infection control policies may help prevent transmission of AROs. However, the most effective strategies for surveillance of AROs in the NICU are unclear. Prior data collected from infants transferred from outside hospitals to 2 NICUs affiliated with New York-Presbyterian (NYP) Hospital detected low rates of ARO colonization in the first week of life. Thus, in 2013 the strategy of performing surveillance on all transferred infants for AROs was changed to performing targeted surveillance on infants transferred at >7 days of life (DOL). The purpose of this study was to assess this change in surveillance strategy and monitor ARO colonization trends in the NICU. METHODS: Data from all infants transported to the NICUs at NYP from 2007 to 2016 were used. Risk factors for colonization with AROs including demographics and admitting diagnoses were explored using a multivariable binomial mixed model clustered by transferring hospital and controlled for NYP NICU. Trends in ARO colonization over time were assessed using negative binomial regression. Site 1 elected not to adopt the change in surveillance policy, and thus was used as a control. RESULTS: From 2007 to 2016, 2925 infants were transferred to the NYP NICUs, 1101 at Site 1 and 1824 at Site 2; 2571 (88%) had surveillance for at least 1 ARO. There were 226 positive surveillance cultures in 204 infants (8%): 94 (3.7%) for MRSA, 78 (3%) for VRE and 54 (2%) for MDR-GNR. In the final models, transfer DOL remained a highly significant (OR per day = 1.018, CI(95) 1.014, 1.022, P < 0.001) predictor of colonization with any ARO. There was no significant increase in the incidence of transferred infants colonized with AROs over time in either NICU; this remained true in infants who were < 7 days of life at Site 1. CONCLUSION: These data continue to support the rationale for our change in surveillance policy. Further studies should evaluate the effect of this strategy on ARO transmission in the general NICU population. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2017-10-04 /pmc/articles/PMC5631502/ http://dx.doi.org/10.1093/ofid/ofx163.1833 Text en © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Duchon, Jennifer
Maykowski, Philip
Good, Pamela
Kytomaa, Sonja
DeLaMora, Patricia
Saiman, Lisa
Surveillance for Antimicrobial-resistant Organisms in Infants Transferred to the Neonatal Intensive Care Unit: Trends in Colonization and Practices
title Surveillance for Antimicrobial-resistant Organisms in Infants Transferred to the Neonatal Intensive Care Unit: Trends in Colonization and Practices
title_full Surveillance for Antimicrobial-resistant Organisms in Infants Transferred to the Neonatal Intensive Care Unit: Trends in Colonization and Practices
title_fullStr Surveillance for Antimicrobial-resistant Organisms in Infants Transferred to the Neonatal Intensive Care Unit: Trends in Colonization and Practices
title_full_unstemmed Surveillance for Antimicrobial-resistant Organisms in Infants Transferred to the Neonatal Intensive Care Unit: Trends in Colonization and Practices
title_short Surveillance for Antimicrobial-resistant Organisms in Infants Transferred to the Neonatal Intensive Care Unit: Trends in Colonization and Practices
title_sort surveillance for antimicrobial-resistant organisms in infants transferred to the neonatal intensive care unit: trends in colonization and practices
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5631502/
http://dx.doi.org/10.1093/ofid/ofx163.1833
work_keys_str_mv AT duchonjennifer surveillanceforantimicrobialresistantorganismsininfantstransferredtotheneonatalintensivecareunittrendsincolonizationandpractices
AT maykowskiphilip surveillanceforantimicrobialresistantorganismsininfantstransferredtotheneonatalintensivecareunittrendsincolonizationandpractices
AT goodpamela surveillanceforantimicrobialresistantorganismsininfantstransferredtotheneonatalintensivecareunittrendsincolonizationandpractices
AT kytomaasonja surveillanceforantimicrobialresistantorganismsininfantstransferredtotheneonatalintensivecareunittrendsincolonizationandpractices
AT delamorapatricia surveillanceforantimicrobialresistantorganismsininfantstransferredtotheneonatalintensivecareunittrendsincolonizationandpractices
AT saimanlisa surveillanceforantimicrobialresistantorganismsininfantstransferredtotheneonatalintensivecareunittrendsincolonizationandpractices